Abstract：
OBJECTIVE: Current European guidelines recommend both eversion carotid endarterectomy (CEA) and conventional CEA with routine patch closure, rather than routine primary closure. Polyester and polytetrafluoroethylene (PTFE) have been used as patch material for a long time. More recently, bovine pericardium has been used; however, there are few studies comparing long term results between bovine pericardium and other patch types. The aim of this study was to investigate the short and long term results after CEA depending on surgical technique and patch material.
METHODS: A registry based study on all primary CEAs (n = 9 205) performed for symptomatic carotid artery stenosis in Sweden from July 2008 to December 2019, cross linked with data from the Swedish stroke registry, Riksstroke, and chart review for evaluation of any events occurring during follow up. The primary endpoint was ipsilateral stroke < 30 days. Secondary endpoints included re-operations due to neck haematoma and < 30 day ipsilateral stroke, > 30 day ipsilateral stroke, all stroke > 30 days, and all cause mortality.
RESULTS: 2 495 patients underwent eversion CEA and 6 710 conventional CEA for symptomatic carotid stenosis. The most commonly used patch material was Dacron (n = 3 921), followed by PTFE (n = 588) and bovine pericardium (n = 413). A total of 1 788 patients underwent conventional CEA with primary closure. Two hundred and seventy-three patients (3.0%) had a stroke < 30 days. Primary closure was associated with an increased risk of ipsilateral stroke and stroke or death <30 days: odds ratio 1.7 (95% confidence interval [CI] 1.2 - 2.4, p = .002); and 1.5 (95% CI 1.2 - 2.0), respectively. During follow up (median 4.2 years), 592 patients had any form of stroke and 1 492 died. There was no significant difference in long term risk of ipsilateral stroke, all stroke, or death depending on surgical technique or patch material.
CONCLUSIONS: There was an increased risk of ipsilateral stroke < 30 days in patients operated on with primary closure compared with eversion CEA and patch angioplasty. There was no difference between primary closure, different patch types, or eversion after the peri-operative phase.
METHODS: A registry based study on all primary CEAs (n = 9 205) performed for symptomatic carotid artery stenosis in Sweden from July 2008 to December 2019, cross linked with data from the Swedish stroke registry, Riksstroke, and chart review for evaluation of any events occurring during follow up. The primary endpoint was ipsilateral stroke < 30 days. Secondary endpoints included re-operations due to neck haematoma and < 30 day ipsilateral stroke, > 30 day ipsilateral stroke, all stroke > 30 days, and all cause mortality.
RESULTS: 2 495 patients underwent eversion CEA and 6 710 conventional CEA for symptomatic carotid stenosis. The most commonly used patch material was Dacron (n = 3 921), followed by PTFE (n = 588) and bovine pericardium (n = 413). A total of 1 788 patients underwent conventional CEA with primary closure. Two hundred and seventy-three patients (3.0%) had a stroke < 30 days. Primary closure was associated with an increased risk of ipsilateral stroke and stroke or death <30 days: odds ratio 1.7 (95% confidence interval [CI] 1.2 - 2.4, p = .002); and 1.5 (95% CI 1.2 - 2.0), respectively. During follow up (median 4.2 years), 592 patients had any form of stroke and 1 492 died. There was no significant difference in long term risk of ipsilateral stroke, all stroke, or death depending on surgical technique or patch material.
CONCLUSIONS: There was an increased risk of ipsilateral stroke < 30 days in patients operated on with primary closure compared with eversion CEA and patch angioplasty. There was no difference between primary closure, different patch types, or eversion after the peri-operative phase.
摘要：
目的：目前的欧洲指南推荐外翻CEA和常规CEA联合常规补片闭合，而是常规的主要关闭。聚酯和聚四氟乙烯(PTFE)已经长期用作贴片材料。最近,牛心包已经使用，然而，很少有研究比较牛心包和其他斑块类型之间的长期结果。这项研究的目的是根据手术技术和补片材料调查CEA后的短期和长期结果。
方法：2008年7月至2019年12月在瑞典对症状性颈动脉狭窄进行的所有原发性CEA（n=9205）进行的基于注册的研究，与瑞典卒中注册的数据相关，Riksstroke,和图表审查评估随访期间发生的任何事件。主要终点为同侧卒中<30天。次要终点是由于颈部血肿和<30天同侧卒中>30天导致的再次手术，所有卒中>30天和全因死亡率。
结果：2495例患者接受外翻CEA和6710例常规CEA治疗症状性颈动脉狭窄。最常用的贴片材料是涤纶（n=3921），其次是PTFE（n=588）和牛心包（n=413）。1788例患者接受了常规CEA和一期闭合。273例患者（3.0%）卒中<30天。初级闭合与同侧卒中和卒中或死亡<30天的风险增加相关。或1.7（95CI1.2-2.4），p=0.002;和1.5(95%CI1.2-2.0)。在随访期间（中位数为4.2年），592例患者有任何形式的中风，1492例死亡。同侧卒中的长期风险没有显着差异，所有中风或死亡取决于手术技术或贴片材料。
结论：与外翻CEA和补片血管成形术相比，初次封堵手术患者患侧卒中<30天的风险增加。初次闭合之间没有区别，围手术期后不同的补片类型或外翻。
方法：2008年7月至2019年12月在瑞典对症状性颈动脉狭窄进行的所有原发性CEA（n=9205）进行的基于注册的研究，与瑞典卒中注册的数据相关，Riksstroke,和图表审查评估随访期间发生的任何事件。主要终点为同侧卒中<30天。次要终点是由于颈部血肿和<30天同侧卒中>30天导致的再次手术，所有卒中>30天和全因死亡率。
结果：2495例患者接受外翻CEA和6710例常规CEA治疗症状性颈动脉狭窄。最常用的贴片材料是涤纶（n=3921），其次是PTFE（n=588）和牛心包（n=413）。1788例患者接受了常规CEA和一期闭合。273例患者（3.0%）卒中<30天。初级闭合与同侧卒中和卒中或死亡<30天的风险增加相关。或1.7（95CI1.2-2.4），p=0.002;和1.5(95%CI1.2-2.0)。在随访期间（中位数为4.2年），592例患者有任何形式的中风，1492例死亡。同侧卒中的长期风险没有显着差异，所有中风或死亡取决于手术技术或贴片材料。
结论：与外翻CEA和补片血管成形术相比，初次封堵手术患者患侧卒中<30天的风险增加。初次闭合之间没有区别，围手术期后不同的补片类型或外翻。
