Long-Term Effectiveness and Safety of Dacron Patch (Uni-Graft^Ⓡ) Closure in Carotid Endarterectomy

Carotid endarterectomy (CEA) remains the gold-standard treatment for high-grade carotid artery stenosis. While patch angioplasty reduces perioperative complications and restenosis risk compared to primary closure, the optimal patch material remains debated. This study evaluates the long-term safety and effectiveness of CEA with Dacron patch closure regarding overall survival, stroke prevention, and restenosis rates.

A retrospective analysis was performed on 200 patients who met the inclusion criteria of either symptomatic carotid stenosis of any degree according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, or asymptomatic stenosis with a NASCET grade ≥70%. All patients underwent CEA with standardized Dacron patch closure. Symptomatic stenosis was defined as ipsilateral transient ischemic attack or stroke within 6 months preoperatively. Perioperative data, survival, stroke-free survival, and freedom from restenosis (≥70% restenosis) were assessed through structured clinical follow-up and serial duplex ultrasound over 5 years. Kaplan-Meier estimates and subgroup analyses were performed according to symptomatic status, baseline stenosis severity, and sex. Log-Rank and/or Wilcoxon Tests were applied to analyze differences between the subgroups.

Among 200 patients, 26 adverse events (12.9%) were observed, with bleeding events exclusively associated with significantly prolonged clamping times (P = 0.0221 and twice P < 0.0001). Most complications (8.0%) occurred during follow-up, and no deaths were linked to stroke or restenosis. At 5 years, overall survival was 93.7%, freedom from stroke was 97.6%, and freedom from restenosis was 97.5%. Symptomatic patients showed slightly lower survival (91.8% vs. 95.7%) and stroke-free survival (96.2% vs. 99.0%) compared to asymptomatic patients, reflecting higher baseline vascular risk. No significant differences in outcome were observed across different NASCET stenosis subgroups. However, a significant sex difference was found in restenosis rates: 5-year freedom from restenosis was lower in women (88.4%) than in men (98.0%; P = 0.017). Stroke rates remained low and similar between sexes.

CEA with Dacron patch closure provides durable long-term stroke protection and patency, with perioperative and late complication rates at the lower end of reported ranges. All bleeding events linked to significantly prolonged clamping times, suggesting intraoperative clamping duration may serve as an early indicator for postoperative bleeding risk. Our data advocate for a potentially increased risk of restenosis in females, which may warrant heightened vigilance and closer duplex ultrasound surveillance during follow-up. These results of this study support the continued use of Dacron patches as a safe and effective option for carotid reconstruction.