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Carotid bypass with polytetrafluoroethylene grafts: a study of 110 consecutive patients
Christophe Camiade1, Amer Maher, Jean-Baptiste Ricco
1Vascular Surgery Department, Jean Bernard University Hospital, Poitiers, France.
Insights
Prosthetic carotid bypass grafting (PCB) offers a viable alternative to carotid endarterectomy (CEA) for complex cases. This PTFE graft technique demonstrates low stroke and occlusion rates, comparable to standard CEA.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Techniques
Background:
- Carotid endarterectomy (CEA) is standard for carotid bifurcation atherosclerosis but can be challenging.
- Prosthetic carotid bypass grafting (PCB) using polytetrafluoroethylene (PTFE) grafts is presented as an alternative.
- This study evaluates the technique and outcomes of PCB.
Purpose of the Study:
- To assess the efficacy and safety of prosthetic carotid bypass grafting (PCB).
- To compare PCB outcomes with established carotid endarterectomy (CEA) results.
- To evaluate PCB for specific challenging carotid stenosis conditions.
Main Methods:
- Retrospective analysis of prospectively collected data from 110 consecutive PCB procedures.
- Data collected between September 1986 and July 2002, representing 9.6% of carotid revascularizations.
- Indications included extensive lesions (40.9%), kinking (26.4%), recurrent stenosis (16.4%), and post-radiation stenosis (6.4%).
Main Results:
- Combined 30-day stroke and death rate was 0.9%.
- Mean follow-up was 647 days; graft occlusion occurred in 3.6%, recurrent stenosis in 0.9%.
- At 3 years, actuarial survival was 81.4% and stroke-free rate was 97.7%; no fatal strokes occurred.
Conclusions:
- Prosthetic carotid bypass grafting (PCB) is a viable treatment for complex carotid lesions.
- PCB is effective for extensive atherosclerotic lesions, recurrent stenosis, and post-radiation stenosis.
- Postoperative outcomes of PCB are comparable to CEA under optimal conditions.
Background:
Carotid endarterectomy (CEA) is the standard treatment for atherosclerotic lesions involving the carotid bifurcation. However, CEA can be challenging under some conditions. We describe the technique and outcome of prosthetic carotid bypass grafting (PCB) with polytetrafluoroethylene (PTFE) grafts as an elective alternative to CEA.
Patients And Methods:
This retrospective analysis of prospectively collected data came from a series of 110 consecutive PCBs, that is, 9.6% of 1140 carotid revascularization procedures performed in our department between September 1986 and July 2002. Primary indications for PCB were extensive atherosclerotic lesions (n = 45, 40.9%), carotid stenosis associated with kinking (n = 29, 26.4%), recurrent stenosis (n = 18, 16.4%), and stenosis after radiation therapy (n = 7, 6.4%).
Results:
The combined stroke and death rate at 30 days was 0.9%. Mean duration of follow-up was 647 +/- 71 days. Four carotid bypass grafts (3.6%) became occluded, and stenosis recurred in 1 (0.9%). At 3 years, overall actuarial survival was 81.4 +/- 11.5 and actuarial stroke-free rate was 97.7 +/- 2.3. There were no fatal strokes.
Conclusion:
PCB is a viable technique for treatment of extensive atherosclerotic carotid lesions, recurrent carotid stenosis, and carotid stenosis after radiation therapy. Postoperative stroke, occlusion, and recurrent stenosis rates are comparable to those associated with CEA performed under optimal conditions.