Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques

• Published in: World journal of surgery Vol. 44; no. 10; pp. 3545 - 3554
• Main Authors: Nana, Petroula, Spanos, Konstantinos, Piffaretti, Gabriele, Koncar, Igor, Kouvelos, George, Zlatanovic, Petar, Tozzi, Matteo, Davidovic, Lazar, Giannoukas, Athanasios
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Cardiac Surgery; Cardiovascular Diseases - epidemiology; Demographics; Demography; Durability; Dyslipidemia; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - methods; Female; General Surgery; Humans; Hypertension; Male; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Original Scientific Report; Patients; Postoperative Complications - epidemiology; Restenosis; Retrospective Studies; Stroke - epidemiology; Surgery; Survival; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-020-05604-0

Background Various techniques have been used for the execution of carotid endarterectomy; primary (PC), patch closure (CP) and eversion technique (ET).The superiority of any of them is still unproven. The aim of this study was to compare the long-term outcomes of each technique in terms of cerebrovascular event (CVE), restenosis, survival and major cardiac event (MACE). Methods Between 2007 and 2018, a retrospective analysis of prospectively recorded data from three European tertiary centers was undertaken including 1.357 patients. Demographics, comorbidities and medical treatment were analyzed in relation to long-term outcomes. Freedom from CVE, restenosis (> 70%), survival and MACE were estimated with Kaplan–Meier analysis curve. Results The mean age was 69.5 ± 8 (72% males;79% asymptomatic). 472 (35%) were treated with PC, 504 (37%) with CP and 381 (28%) with ET. Differences among groups were observed in age ( P  < 0.001), gender ( P  < 0.01), hypertension ( P  = 0.01), dyslipidemia ( P  < 0.001) and statin treatment ( P  < 0.001). The mean follow-up was 4.7 ± 3 years (median: 5 years). Seventy-three patients presented a CVE during 8 years of follow-up. The freedom from CVE including all techniques was 96% (SE 0.6%), 93% (SE 1%) and 89% (SE 1.6%), at 2, 5 and 8 years of follow-up, respectively, with no difference between groups (P .289). Freedom from restenosis was at 96% (SE 0.7%) and 89% (SE 5%) at 5 and 10 years, respectively, for all methods without differences. ET was associated with a higher mortality rate ( P  < 0.001) and MACE rate ( P  < 0.001). Conclusions Excellent outcomes were achieved with all types of closure techniques with low rates of MACE and other adverse events during long-term follow-up after CEA.