Three-year Results for 801 Patients and 917 Operations
- 1 November 1987
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 208 (5), 628-635
- https://doi.org/10.1097/00000658-198711000-00013
Abstract
From 1983 through 1985, 801 consecutive patients (mean age: 66 years) underwent 917 primary carotid endarterectomies at the Cleveland Clinic. Conventional arteriotomy closure was performed during 483 operations, while patch angioplasty using a distal segment of saphenous vein was employed in 434. Preoperative risk factors, surgical management, and antiplatelet therapy were equivalent in the vein patch (VP) and nonpatch (NP) groups. Early results were evaluated by intravenous angiography (DSA) in 715 patients (89%), and 332 reconstructions (36%) have been reassessed by objective imaging during a mean follow-up interval of 21 months. Ischemic strokes occurred after 18 (1.9%) of the 917 procedures (0.7% VP, 3.1% NP; p = 0.0084), and symptomatic (N = 9) or unsuspected (N = 8) thrombosis of the internal carotid artery was confirmed by neck exploration or routine DSA after 1.9% of all operations (0.5% VP, 3.1% NP; p = 0.0027). Only ten patients (1.2%) have required reoperations for severe recurrent lesions, but the cumulative 3-year incidence of new defects (greater than or equal to 30% stenosis) documented by objective studies in the VP and NP groups was 9% and 31%, respectively (p = 0.0066). These results strongly suggest that VP angioplasty enhances the safety and durability of carotid endarterectomy.Keywords
This publication has 38 references indexed in Scilit:
- Outcome in Patients with Asymptomatic Neck BruitsNew England Journal of Medicine, 1986
- Carotid endarterectomy. Long term follow-up with specific reference to recurrent stenosis, contralateral progression, mortality and recurrent neurological episodes.1986
- Recurrent Versus Residual Carotid StenosisAnnals of Surgery, 1986
- Clinicopathologic correlation in postendarterectomy recurrent stenosis. A case report and bibliographic review.1986
- Recurrent Carotid StenosisAnnals of Surgery, 1986
- The case against surgery for asymptomatic carotid stenosis.Stroke, 1984
- Carotid endarterectomy: does it work?Stroke, 1984
- Carotid endarterectomy without a shunt: the control series.1984
- Carotid Artery Stenosis Following EndarterectomyArchives of Surgery, 1982
- Recurrent carotid stenosis.1976