Counsell C, Salinas R, Warlow C, Naylor R
Neurosciences Trials Unit, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
Cochrane Database Syst Rev. 2000(2):CD000160. doi: 10.1002/14651858.CD000160.
Carotid patch angioplasty (with either a venous or a synthetic patch) may reduce the risk of carotid artery restenosis and subsequent ischaemic stroke.
The objective of this review was to assess the effect of routine or selective carotid patch angioplasty compared to carotid endarterectomy with primary closure.
We searched the Cochrane Stroke Group trials register, Medline (1966 to 1995), Embase (1980 to 1995) and Index to Scientific and Technical Proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular and Endovascular Surgery (1987 to 1995) and World Journal of Surgery (1978 to 1995).
Randomised trials comparing carotid patch angioplasty with primary closure in any patients undergoing carotid endarterectomy.
Two reviewers independently assessed eligibility, trial quality and extracted the data.
Six trials involving 794 patients and 882 operations were included. The quality of trials was generally poor. Follow-up varied from hospital discharge to five years. Carotid patch angioplasty showed a reduction in the risk of stroke of any type, ipsilateral stroke, and stroke or death, during the perioperative period and longterm follow-up. However, data were not available from all trials, the number of events was small and there was significant loss to follow-up. Patching appeared to reduce the risk of perioperative arterial occlusion (six trials, odds ratio 0.17, 95% confidence interval 0.06 to 0.46). Patching was also associated with decreased restenosis during longterm follow-up in five trials, (odds ratio 0.32, 95% confidence interval 0.19 to 0.53). However, these results are uncertain because of loss to follow-up and the small number of events. Very few arterial complications, including haemorrhage, infection, cranial nerve palsies and pseudo-aneurysm formation were recorded with either patch or primary closure.
REVIEWER'S CONCLUSIONS: Limited evidence suggests that carotid patch angioplasty may lower the risk of perioperative arterial occlusion and restenosis. It is unclear whether this reduces the risk of death or stroke.
颈动脉补片血管成形术（使用静脉补片或人工合成补片）可能降低颈动脉再狭窄及后续缺血性卒中的风险。
本综述的目的是评估常规或选择性颈动脉补片血管成形术与一期缝合颈动脉内膜切除术相比的效果。
我们检索了Cochrane卒中组试验注册库、Medline（1966年至1995年）、Embase（1980年至1995年）以及《科技会议录索引》（1980年至1994年）。我们还手工检索了《外科学年鉴》（1981年至1995年）、《英国外科学杂志》（1985年至1995年）、《欧洲血管与腔内血管外科学杂志》（1987年至1995年）以及《世界外科学杂志》（1978年至1995年）。
在任何接受颈动脉内膜切除术的患者中，比较颈动脉补片血管成形术与一期缝合的随机试验。
两名评价者独立评估入选资格、试验质量并提取数据。
纳入了6项试验，涉及794例患者和882例手术。试验质量总体较差。随访时间从出院至5年不等。颈动脉补片血管成形术在围手术期和长期随访期间显示出任何类型卒中、同侧卒中和卒中或死亡风险的降低。然而，并非所有试验都有数据，事件数量较少且失访情况严重。补片似乎降低了围手术期动脉闭塞的风险（6项试验，比值比0.17，95%置信区间0.06至0.46）。在5项试验中，补片还与长期随访期间再狭窄的减少相关（比值比0.32，95%置信区间0.19至0.53）。然而，由于失访和事件数量较少，这些结果尚不确定。使用补片或一期缝合记录到的动脉并发症（包括出血、感染、颅神经麻痹和假性动脉瘤形成）都非常少。
有限的证据表明，颈动脉补片血管成形术可能降低围手术期动脉闭塞和再狭窄的风险。目前尚不清楚这是否能降低死亡或卒中的风险。
