Patch angioplasty versus primary closure for carotid endarterectomy

Area of Science:

• Vascular Surgery
• Neurology
• Cardiovascular Medicine

Background:

• Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
• Patch angioplasty is a technique used during CEA to reduce complications.
• This review updates previous analyses of patch angioplasty's efficacy and safety.

Purpose of the Study:

• To assess the safety and efficacy of carotid patch angioplasty compared to primary closure in CEA.
• To determine if patch angioplasty reduces restenosis and subsequent strokes.
• To evaluate perioperative complications associated with patch angioplasty.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched multiple databases including Cochrane Stroke Group register, CENTRAL, MEDLINE, and Embase.
• Assessed eligibility, risk of bias, extracted data, and determined evidence certainty using GRADE.

Main Results:

• Carotid patch angioplasty may reduce the risk of perioperative arterial occlusion and long-term restenosis.
• It appears to lower the risk of ipsilateral stroke during perioperative and long-term follow-up.
• No significant increase in perioperative complications or stroke-related death was observed, but evidence certainty is very low to low.

Conclusions:

• Carotid patch angioplasty may reduce the risk of occlusion and restenosis after CEA.
• It may also reduce the risk of ipsilateral and overall stroke.
• The overall certainty of evidence is limited due to the poor quality of included trials.