Comparative Analysis Using Propensity Score Matching Analysis: Primary Closure versus Patch Angioplasty During...

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Surgical Techniques

Background:

• Controversy exists regarding primary closure (PC) versus patch angioplasty (PA) in carotid endarterectomy (CEA).
• Some studies suggest PC may lead to higher restenosis rates.
• This study aimed to compare PC and PA outcomes using propensity score matching (PSM).

Purpose of the Study:

• To evaluate and compare the perioperative and long-term outcomes of primary closure (PC) and patch angioplasty (PA) following carotid endarterectomy (CEA).
• To determine if differences in restenosis rates or other complications exist between PC and PA closure methods.

Main Methods:

• Retrospective analysis of 1,044 patients undergoing CEA between 1994 and 2016.
• Propensity score matching (PSM) was used to balance baseline characteristics between PC and PA groups, analyzing 377 matched pairs.
• Endpoints included perioperative stroke, cranial nerve palsy, hematoma, bleeding requiring reoperation, and long-term restenosis, survival, and stroke-free survival rates.

Main Results:

• No significant differences were observed between PC and PA groups in ipsilateral stroke, clinical stroke, cranial nerve palsy, hematoma, or reoperation for bleeding within 30 days post-surgery.
• Restenosis rates during follow-up also showed no statistically significant difference between the two closure methods (P=0.16).
• Long-term outcomes, including overall survival, stroke-free survival, and restenosis-free survival, were comparable between the PC and PA groups.

Conclusions:

• Propensity score matching analysis indicates no significant differences in perioperative or long-term outcomes between primary closure and patch angioplasty for carotid endarterectomy.
• Both closure techniques appear to be safe and effective for CEA procedures.