The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up.

Abstract

A prospective study was undertaken in March 1980, at the Vascular Surgery Department of the Padua University, Medical School, to establish whether patch graft angioplasty is useful in preventing restenosis after carotid endarterectomy (CE). Seventy-four patients underwent 86 CE (bilateral in 12 cases) for atherosclerotic disease involving the carotid bifurcation. Thirty-eight (51.4%) patients presented TIA's or non hemispheric symptoms of cerebrovascular insufficiency; 30 (40.5%) were asymptomatic and 6 (8.1%) had partial nonprogressing or fixed strokes. All operations were performed under general anesthesia, with pharmacologic hypertension and systemic heparinization; in all cases, continuous EEG monitoring and 'stump pressure' measurement were employed. The operation was performed without a temporary intraluminal shunt in the patients showing tolerance to carotid clamping. The protection of the shunt was required only in patients with EEG monitoring changes (17). All carotid arteriotomies were extended into the internal carotid artery to overpass the end of the endarterectomy. Overpass was also used in the proximal edge of the arteriotomy, in the common carotid artery. The distal intima was never fixed with stitches and the arteriotomy was routinely closed with a PTFE patch graft angioplasty. Early results of cerebral protection were excellent. No patient presented permanent or transient postoperative neurological problems and no patient died in the postoperative period for causes related to the operation. This is substantiated by results we achieved during the period 1970-1979 in 192 patients, when all carotid endarterectomies were routinely performed without a shunt, with figures of 2.5% of postoperative stroke and 1.5% of mortality. Longterm follow-up (from 6 to 36 months) was completed in 51 patients (60 operations).(ABSTRACT TRUNCATED AT 250 WORDS)