PATCH ANGIOPLASTY INCREASES PLATELET DEPOSITION FOLLOWING CAROTID ENDARTERECTOMY

1987 ◽  
Author(s):  
A C Meek ◽  
P Jarvis ◽  
R A Harper ◽  
C N McCollum
Keyword(s):  
Carotid Endarterectomy ◽  
Gamma Camera ◽  
Thrombus Formation ◽  
Uptake Ratio ◽  
Simple Closure ◽  
Patch Angioplasty ◽  
Significant Difference ◽  
Patch Closure ◽  
Platelet Accumulation ◽  
Dacron Patch

Patch angioplasty with vein or Dacron may be required to prevent narrowing when the arteriotomy is closed following carotid endarterectomy. We studied the effect of such patches on intraluminal thrombus formation by measuring radiolabelled platelet uptake in patients following simple closure and patch angioplasty.Following unilateral carotid endarterectomy in 33 patients, the arteriotomy was closed by direct suture in 23, Dacron patch in 6 and saphenous vein patch in 4. Autologous 111In-platelets were infused on the second postoperative day and platelet uptake over the carotid measured on daily gamma camera images for 3 days. Radioactivity over the operated and contralateral carotids were compared as the Carotid Uptake Ratio.Mean (±sem) counts per gamma camera cell at 24 hours in the operated carotid of 43.6±3.0 were consistently higher than the reference artery of 35.4±2.4 (p<0.001). The overall carotid uptake ratio was 1.21±0.04 with that of 1.41±0.07 in patch angioplasty significantly higher than 1.14±0.04 found following standard arteriotomy closure (p<0.01). All 10 patch angioplasties were easily visible as "hot spots" on gamma camera compared to only 11 out of 23 with simple closure but there was no significant difference between platelet uptake with vein or Dacron patches with ratios of 1.47±0.35 and 1.37±0.15 respectively (p>0.5).The greater local platelet accumulation with patch angioplasty may be due to turbulence from excessive widening of the vessel combined with the thrombogenic surface following endarterectomy. Until the significance of platelet accumulation is established platelet inhibitory therapy should be considered when patch closure is unavoidable.

PLATELET DEPOSITION AFTER CAROTID ENDARTERECTOMY DECREASES WITH TIME.

1987 ◽  
Author(s):  
A C Meek ◽  
P Jarvis ◽  
C M Backhouse ◽  
CN McCollum ◽  
RM Greenhalgh
Keyword(s):  
Carotid Endarterectomy ◽  
Intimal Hyperplasia ◽  
Gamma Camera ◽  
Contralateral Side ◽  
Uptake Ratio ◽  
Platelet Deposition ◽  
Platelet Accumulation

Platelets are deposited on the exposed media following carotid endarterectomy and will continue to accumulate until neointima covers this thrombogenic surface. Radiolabelled platelet uptake was measured to assess the time to intimal repair.Autologous llllndium labelled platelets were infused 2 days and 2 months postoperatively in 10 patients undergoing unilateral carotid endarterectomy. Platelet accumulation was measured daily by gamma camera images counting radioactivity over the operated artery and comparing it to the contralateral side as Carotid Uptake Ratio (CUR).Mean (±sem) counts per gamma camera cell over the operated side at 24 hours were 46.3± 4.3 compared to 38.6± 3.9 on the unoperated side (p<0.001). At 2 months this difference had disappeared with counts of 38.8± 3.2 and 39.1± 3.2 over the operated and reference arteries respectively. Early postoperative CUR at 1.22± 0.04 was significantly higher than 1.01± 0.06 at 2 months which equates to no radiolabelled platelet uptake (p< 0.01). Radioiabellea platelet uptake was visible on 8 of the 10 early scans, but this was seen in only 2 patients at 2 months, both of whom had a persistently high CUR indicating continued platelet accumulation at that time.Early postoperative platelet deposition decreases in the weeks following carotid endarterectomy presumably due to the development of a neointima. Those cases with persistently high platelet accumulation may have luminal thrombus which could lead intimal hyperplasia and restenosis.

Atherosclerotic Aneurysms Following Carotid Endarterectomy with Dacron Patch Angioplasty: An Unreported Complication

1999 ◽  
Vol 33 (1) ◽  
pp. 87-92 ◽  
Author(s):  
A. Byer ◽  
T. E. Quirke ◽  
P. C. Ritota ◽  
R. C. Keys ◽  
B. Marcus
Keyword(s):  
Carotid Endarterectomy ◽  
Patch Angioplasty ◽  
Dacron Patch

A Randomized Trial of Synthetic Patch versus Direct Primary Closure in Carotid Endarterectomy

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 822-829 ◽  
Author(s):  
Pippa G. Al-Rawi ◽  
Carole L. Turner ◽  
Vicknes Waran ◽  
Ivan Ng ◽  
Peter J. Kirkpatrick
Keyword(s):  
Clinical Outcome ◽  
Carotid Endarterectomy ◽  
Duplex Ultrasound ◽  
Vessel Occlusion ◽  
Direct Closure ◽  
Patch Angioplasty ◽  
Significant Difference ◽  
Vessel Patency ◽  
Closure Group ◽  
Patch Group

Abstract OBJECTIVE: To define whether or not direct microscopic closure with or without the use of a vascular patch is advantageous in terms of clinical outcome and late vessel occlusion rates after microsurgical carotid endarterectomy. METHODS: Three hundred thirty-eight elective carotid endarterectomies in 315 patients were randomized to direct arteriotomy or closure with a polyester collagen-coated vascular patch. Ten procedures did not follow the randomization process because of technical difficulties and were excluded. Vessel patency (duplex ultrasound) and outcome were assessed during and immediately after surgery and at 4 and 12 months after surgery. RESULTS: Four-month ultrasound assessment (n = 321) identified five occluded vessels: two in the patch group (n = 149) and three in the direct closure group (n = 172). Six patients in the patch group had died or were significantly disabled at 4 months, compared with five in the direct closure group. At the 12-month assessment (n = 313), eight vessels had occluded: five from the patched group (n = 146) and three from the direct closure group (n = 167). Eight patients in the patch group had died or were significantly disabled, compared with four in the direct closure group. No statistically significant difference between the two groups in terms of vessel occlusion, morbidity, or mortality was seen (P &gt; 0.1). CONCLUSION: No difference in vessel patency and clinical outcome has been identified after microscopic patch angioplasty and direct arteriotomy repair. The authors conclude that there is no benefit from the routine use of patch angioplasty in microscopic carotid endarterectomy.

Comparison of primary closure with dacron patch angioplasty in early and late restenosis after carotid endarterectomy

2001 ◽  
Vol 88 (4) ◽  
pp. 599-599
Author(s):  
D. J. Gerrard ◽  
A. H. Hatrick ◽  
R. A. Dourado ◽  
H. Patel ◽  
A. T. Irvine ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Patch Angioplasty ◽  
Dacron Patch ◽  
Late Restenosis

Abstract 115: Is Routine Patching Necessary Following Carotid Endarterectomy (CEA)?

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Nicholas J Gargiulo
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Retrospective Review ◽  
Primary Closure ◽  
Perioperative Stroke ◽  
Symptomatic Carotid ◽  
Significant Difference ◽  
Patch Closure ◽  
Closure Group

Objectives: Large medicare databases and meta-analyses recommend routine patching following carotid endarterectomy (CEA). Routine patching reduces perioperative stroke, carotid thrombosis, and restenosis. This 30 year experience evaluates the long term outcome of CEA with selective patching and without routine postoperative duplex examination. Methods: An IRB-approved retrospective review of all CEAs peformed by two surgeons over a 30 year period (1984-2014). Pre-operative imaging studies, operative reports, physical findings, co-morbid conditions, and pre- and postoperative medications were evaluated. Results: Over a 30-year period, 439 CEAs were performed for symptomatic carotid disease using a selective patch technique depending on gender, internal carotid artery diameter, cardiovascular risk factors, and preoperative arteriogram. In this group of 439 patients, 17 (3.9%) had patch closure of the carotid artery and the other 422 (96.1%) had primary closure. There were 2 (0.47%) perioperative strokes in the primary closure group and 4 (0.95%) patients in this group developed symptomatic carotid restenosis at a mean follow-up of 49.5 months (range 1 to 237 months). There was 1 (5.8%) carotid thrombosis in the patch closure group who also had a perioperative stroke and was serologically positive for a hypercoagulable disorder. The 4 patients who developed symptomatic restenosis had arteriographically proven > 90% stenosis and required repeat CEA. The remaining 418 (99.0%) patients having primary closure remained neurologically asymptomatic (mean follow-up 10.3 years, range 2.5 to 17 years). There was 1 (0.23%) operative death that occurred following the induction of general anesthesia. Conclusions: In this experience, there is no statistically significant difference in restenosis in the primary closure group and selective patch group following CEA. Although this data set is a small, single center, two surgeon, retrospective review, it does not support the generally well accepted view of routine patching following CEA

Effect of perioperative platelet inhibition on postcarotid endarterectomy mural thrombus formation

1985 ◽  
Vol 63 (5) ◽  
pp. 693-698 ◽  
Author(s):  
J. Max Findlay ◽  
William M. Lougheed ◽  
Fred Gentili ◽  
Paul M. Walker ◽  
Michael F. X. Glynn ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Thrombus Formation ◽  
Treated Group ◽  
Platelet Inhibition ◽  
Mural Thrombus ◽  
Double Blind ◽  
Content Type ◽  
Indium 111 ◽  
Platelet Accumulation

✓ A prospective randomized double-blind trial was conducted to study the effect of platelet-inhibiting drugs on mural thrombus formation after carotid endarterectomy. Twenty-two patients undergoing carotid endarterectomy were randomly assigned to perioperative administration of an aspirin/dipyridamole combination or a placebo, and the postoperative results were compared. Autologous indium-111-labeled platelets were injected postoperatively, and platelet deposition was measured at the endarterectomy site. It was found that the treated group had a significant reduction in platelet accumulation compared with the placebo group. The results suggest that the perioperative use of aspirin/dipyridamole may reduce the risk of operative stroke and the long-term risk of repeat carotid stenosis.

scholarly journals Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience

2022 ◽  
Vol 13 ◽  
pp. 1
Author(s):  
Nirmeen Zagzoog ◽  
Ali Elgheriani ◽  
Ahmed Attar ◽  
Radwan Takroni ◽  
Majid Aljoghaiman ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Retrospective Chart Review ◽  
Single Institution ◽  
Recurrent Stenosis ◽  
Doppler Ultrasound Imaging ◽  
Patch Angioplasty ◽  
Comprehensive Comparison ◽  
Patch Closure

Background: 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. Methods: 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. Results: 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%; P = 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; P = 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. Conclusion: Both primary closure and patch closure techniques seem to have similar risk profiles and are equally robust techniques to utilize for CEA procedures.

scholarly journals Patch Angioplasty or Primary Closure Following Carotid Endarterectomy for Symptomatic Carotid Artery Stenosis

2018 ◽  
Vol 04 (02) ◽  
pp. e96-e101 ◽  
Author(s):  
Eline Huizing ◽  
Cornelis Vos ◽  
Robin Hulsebos ◽  
Peter van den Akker ◽  
Gert Borst ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Group Versus ◽  
Patient Characteristics ◽  
Symptomatic Carotid ◽  
Patch Angioplasty ◽  
Eversion Endarterectomy ◽  
Patch Closure ◽  
Symptomatic Stenosis

Objectives Guidelines recommend routine patching to prevent restenosis following carotid endarterectomy, mainly based on studies performed many years ago with different perioperative care and medical treatment compared with current standards. Aim of the present study was to compare primary closure (PRC) versus patch closure (PAC) in a contemporary cohort of patients. Methods Consecutive patients treated by carotid endarterectomy for symptomatic stenosis between January 2006 and April 2016 were retrospectively analyzed. Primary outcome was restenosis at 6 weeks and 1 year and occurrence of ipsilateral stroke. Secondary outcomes were mortality, complications, and reintervention rates. Results Five hundred carotid artery endarterectomies were performed. Fifty-nine patients were excluded because eversion endarterectomy was performed or because they were asymptomatic. PRC was performed in 349 and PAC in 92 patients. Restenosis at 6 weeks was 6.0% in the PAC group versus 3.0% in the PRC group (p = 0.200). Restenosis at 1 year was 31.6 versus 14.1%, respectively (p = 0.104). No difference was found for stroke (3.4 vs 1.1%, p = 0.319), death (1.1 vs 0.0%, p = 0.584), or other complications (1.1 vs 0.0%, p = 0.584), respectively. Conclusions It remains unclear whether routine patching should be recommended for all patients. A strategy of selective patching compared with routine patching, based on internal carotid artery diameter and other patient characteristics, deserves further investigation.

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