Zagzoog Nirmeen, Elgheriani Ali, Attar Ahmed, Takroni Radwan, Aljoghaiman Majid, Klotz Lisa, Vandervelde Cheyanne, Darling Chloe, Farrokhyar Forrough, Martyniuk Amanda, Algird Almunder
Department of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
Department of Internal Medicine, University of Manitoba, Manitoba, Canada.
Surg Neurol Int. 2022 Jan 5;13:1. doi: 10.25259/SNI_1013_2021. eCollection 2022.
Carotid endarterectomy (CEA) is an effective intervention for the treatment of high-grade carotid stenosis. Technical preferences exist in the operative steps including the use patch for arteriotomy closure. The goals of this study are to compare the rate of postoperative complications and the rate of recurrent stenosis between patients undergoing primary versus patch closure during CEA.
Retrospective chart review was conducted for patients who underwent CEA at single institution. Vascular surgeons mainly performed patch closure technique while neurosurgeons used primary closure. Patients' baseline characteristics as well as intraprocedural data, periprocedural complications, and postprocedural follow-up outcomes were captured.
Seven hundred and thirteen charts were included for review with mean age of 70.5 years (SD = 10.4) and males representing 64.2% of the cohort. About 49% of patients underwent primary closure while 364 (51%) patients underwent patch closure. Severe stenosis was more prevalent in patients receiving patch closure (94.5% vs. 89.4%; = 0.013). The incidence of overall complications did not differ between the two procedures (odds ratio = 1.23, 95% confidence intervals = 0.82-1.85; = 0.353) with the most common complications being neck hematoma, strokes, and TIA. Doppler ultrasound imaging at 6 months postoperative follow-up showed evidence of recurrent stenosis in 15.7% of the primary closure patients compared to 16% in patch closure cohort.
Both primary closure and patch closure techniques seem to have similar risk profiles and are equally robust techniques to utilize for CEA procedures.
颈动脉内膜切除术（CEA）是治疗重度颈动脉狭窄的有效干预措施。手术步骤存在技术偏好，包括动脉切开闭合时使用补片。本研究的目的是比较CEA期间接受直接缝合与补片闭合的患者术后并发症发生率和再狭窄率。
对在单一机构接受CEA的患者进行回顾性病历审查。血管外科医生主要采用补片闭合技术，而神经外科医生使用直接缝合。记录患者的基线特征以及术中数据、围手术期并发症和术后随访结果。
纳入713份病历进行审查，平均年龄70.5岁（标准差=10.4），男性占队列的64.2%。约49%的患者接受直接缝合，而364例（51%）患者接受补片闭合。接受补片闭合的患者中重度狭窄更为普遍（94.5%对89.4%；P=0.013）。两种手术的总体并发症发生率无差异（优势比=1.23，95%置信区间=0.82-1.85；P=0.353），最常见的并发症是颈部血肿、中风和短暂性脑缺血发作。术后6个月的多普勒超声成像显示，直接缝合组15.7%的患者有再狭窄迹象，补片闭合组为16%。
直接缝合和补片闭合技术似乎具有相似的风险特征，并且都是用于CEA手术的同样可靠的技术。
