[Rationale for using a patch graft in carotid endarterectomy]

To determine whether carotid patch angioplasty influences early and long-term complications after carotid endarterectomy.

Six prospective, randomized trials (882 procedures) compared effectiveness of patch angioplasty with primary closure after carotid endarterectomy: statistical Odds Ratio analyses was performed. We also thought it appropriate to report our personal experience: a consecutive series of 758 patients (615 males and 143 females) who, from January 1980 to February 1996, underwent 850 procedures of carotid endarterectomy using P.T.F.E. patch, assessing early (at 30 days) results and the long-terms one relative to the period from 1980 to 1990.

Odds Ratio analyses performed have documented that patch angioplasty is more effective then primary closure in reducing the risk of ipsilateral stroke and early and long term Neurological Relevant Complication Rate (NRCR). Significant reduction in restenosis > 50%, using the patch, is assessed. Our personal experience have assessed an early N.R.C.R. of 1.05% and a long term NRCR of 3.3% at five years and 13.3% at 16 years. Restenosis greater of 50% was assessed in 10% of patients. Moreover only in 3% of patients was assessed restenosis > 80% or arterial occlusion.

Reduction in risk of perioperative and postoperative ipsilateral stroke and NRCR using patch angioplasty appears clinically and statistically significant. Moreover this method increase the diameter of the carotid artery lumen, seat for potential development of myointimal proliferation or atherosclerosis.