Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques
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ORIGINAL SCIENTIFIC REPORT
Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques Petroula Nana1 • Konstantinos Spanos1 • Gabriele Piffaretti2 • Igor Koncar3 George Kouvelos1 • Petar Zlatanovic3 • Matteo Tozzi2 • Lazar Davidovic3 • Athanasios Giannoukas1
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract 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.
Introduction & Petroula Nana [email protected] 1
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110 Larissa, Greece
2
Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Circolo University Teaching Hospital, Vare`se, Italy
3
Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
Carotid endarterectomy (CEA) remains the standard of care in patients with symptomatic and asymptomatic severe carotid artery stenosis [1, 2]. As carotid revascularization focuses on the prevention of cerebral ischemic events, its impact on the asymptomatic patients is crucial. Successful CEA in asymptomatic patients reduces by half the 10-year stroke risk, in terms of major or fatal cerebrovascular events while in patients that had previously suffered a stroke or TIA, CEA is even more beneficial [3, 4]. The evolution of the opti
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