Division of Surgery and Interventional Science, University College London, London, UK.
Faculty of Health and Medical Sciences, Surgery, University of Western Australia, Perth, Australia.
Eur J Vasc Endovasc Surg. 2021 Oct;62(4):513-521. doi: 10.1016/j.ejvs.2021.06.028. Epub 2021 Aug 25.
Closure of the artery during carotid endarterectomy (CEA) can be done with or without a patch, or performed with the eversion technique, while the use of intra-operative shunts is optional. The influence of these techniques on subsequent restenosis is uncertain. Long term carotid restenosis rates and risk of future ipsilateral stroke with these techniques were compared.
Patients who underwent CEA in the International Carotid Stenting Study were divided into patch angioplasty, primary closure, or eversion endarterectomy. Intra-operative shunt use was reported. Carotid duplex ultrasound was performed at each follow up. Primary outcomes were restenosis of ≥ 50% and ≥ 70%, and ipsilateral stroke after the procedure to the end of follow up.
In total, 790 CEA patients had restenosis data at one and five years. Altogether, 511 (64.7%) had patch angioplasty, 232 (29.4%) primary closure, and 47 (5.9%) eversion endarterectomy. The cumulative incidence of ≥ 50% restenosis at one year was 18.9%, 26.1%, and 17.7%, respectively, and at five years it was 25.9%, 37.2%, and 30.0%, respectively. There was no difference in risk between the eversion and patch angioplasty group (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.45 - 1.81; p = .77). Primary closure had a higher risk of restenosis than patch angioplasty (HR 1.45, 95% CI 1.06 - 1.98; p = .019). The cumulative incidence of ≥ 70% restenosis did not differ between primary closure and patch angioplasty (12.1% vs. 7.1%, HR 1.59, 95% CI 0.88 - 2.89; p = .12) or between patch angioplasty and eversion endarterectomy (4.7%, HR 0.45, 95% CI 0.06 - 3.35; p = .44). There was no effect of shunt use on the cumulative incidence of restenosis. Post-procedural ipsilateral stroke was not more common in either of the surgical techniques or shunt use.
Restenosis was more common after primary closure than conventionally with a patch closure. Shunt use had no effect on restenosis. Patch closure is the treatment of choice to avoid restenosis.
颈动脉内膜切除术（CEA）过程中可以使用或不使用补片进行动脉闭合，也可以采用外翻技术，而术中使用分流器则是可选的。这些技术对随后的再狭窄的影响尚不确定。比较了这些技术的长期颈动脉再狭窄率和同侧中风的风险。
国际颈动脉支架研究中接受 CEA 的患者分为补片血管成形术、一期闭合或外翻内膜切除术。报告术中使用分流器的情况。每次随访时均行颈动脉双功能超声检查。主要结果是≥50%和≥70%的再狭窄以及手术后至随访结束时同侧卒中。
共有 790 例 CEA 患者在一年和五年时有再狭窄数据。总共 511 例（64.7%）接受补片血管成形术，232 例（29.4%）接受一期闭合，47 例（5.9%）接受外翻内膜切除术。一年时≥50%再狭窄的累积发生率分别为 18.9%、26.1%和 17.7%，五年时分别为 25.9%、37.2%和 30.0%。外翻和补片血管成形术组之间的风险无差异（风险比 [HR]0.90，95%置信区间 [CI]0.45-1.81；p=0.77）。一期闭合的再狭窄风险高于补片血管成形术（HR1.45，95%CI1.06-1.98；p=0.019）。一期闭合和补片血管成形术之间≥70%的再狭窄累积发生率没有差异（12.1%比 7.1%，HR1.59，95%CI0.88-2.89；p=0.12），或补片血管成形术和外翻内膜切除术之间（4.7%，HR0.45，95%CI0.06-3.35；p=0.44）。分流器的使用对再狭窄的累积发生率没有影响。术后同侧卒中在任何一种手术技术或分流器使用中均不常见。
与传统的补片闭合相比，一期闭合后再狭窄更为常见。分流器的使用对再狭窄没有影响。补片闭合是避免再狭窄的首选治疗方法。
