Power Foley M, Doolan N, Connelly T, McMonagle M P
University Hospital Waterford, Ireland.
Ann R Coll Surg Engl. 2025 Sep;107(7):495-502. doi: 10.1308/rcsann.2024.0097. Epub 2025 Apr 3.
Carotid endarterectomy (CEA) with patch angioplasty is associated with lower restenosis rates compared with primary closure alone. However, evidence regarding patch-material superiority in the mitigation against neointimal hyperplasia and restenosis is limited. This retrospective observational study investigated medium-term restenosis rates between commercially available biological and synthetic carotid patches.
All primary CEA with patch angioplasty performed between 2007 and 2019 at a single university hospital were identified from theatre records. Restenosis was defined using the European Society for Vascular Surgery duplex criteria, either moderate (50-69%, PSV >213cm/s) or critical (70-99%, PSV >274cm/s). Chi-square tests and Kaplan-Meier curves were used to compare restenosis rates between biological (bovine pericardium) and synthetic patches (Dacron, PFTE and polyester-urethane).
Overall, 127 CEAs were included in the restenosis analysis. Bovine pericardium was the patch material used most frequently (60%, =75). Median follow-up with duplex was 40.0 months (range 0-144). Moderate restenosis was detected in 14 CEAs (11%) and critical restenosis in 10 (7.8%). Compared with synthetic material, bovine was significantly associated with >50% restenosis but not >70% (=0.042 and =0.197, respectively). However, Kaplan-Meier curves demonstrated similar rates of >50% and >70% restenosis between patch types at five years (=0.081 and =0.080, respectively). There was no significant difference in peri-operative complication rates between patch types.
These results indicate medium-term restenosis rates after CEA are similar between biological and synthetic patches. However, well-designed randomised control trials are required to definitively answer the question of which patch material is superior for carotid reconstruction.
与单纯一期缝合相比，颈动脉内膜切除术（CEA）联合补片血管成形术的再狭窄率较低。然而，关于补片材料在减轻内膜增生和再狭窄方面优越性的证据有限。这项回顾性观察研究调查了市售生物和合成颈动脉补片的中期再狭窄率。
从手术记录中识别出2007年至2019年在一家大学医院进行的所有一期CEA联合补片血管成形术。再狭窄采用欧洲血管外科学会的双功超声标准定义，分为中度（50 - 69%，PSV>213cm/s）或重度（70 - 99%，PSV>274cm/s）。采用卡方检验和Kaplan - Meier曲线比较生物补片（牛心包）和合成补片（涤纶、聚四氟乙烯和聚酯 - 聚氨酯）的再狭窄率。
总体而言，127例CEA纳入再狭窄分析。牛心包是最常用的补片材料（60%，n = 75）。双功超声的中位随访时间为40.0个月（范围0 - 144个月）。14例CEA检测到中度再狭窄（11%），10例检测到重度再狭窄（7.8%）。与合成材料相比，牛心包与>50%再狭窄显著相关，但与>70%再狭窄无关（分别为P = 0.042和P = 0.197）。然而，Kaplan - Meier曲线显示，5年后不同补片类型的>50%和>70%再狭窄率相似（分别为P = 0.081和P = 0.080）。不同补片类型的围手术期并发症发生率无显著差异。
这些结果表明，CEA术后生物补片和合成补片的中期再狭窄率相似。然而，需要设计良好的随机对照试验来明确回答哪种补片材料在颈动脉重建中更具优势的问题。
