Abstract：
Currently, the type of patch used for carotid endarterectomy closure depends on the preference of the operating surgeon. Various materials are available, including autologous venous patches, bovine pericardial patches (BPP), and synthetic patches. The purpose of this study was to compare the long-term outcomes.
All patients who underwent primary carotid endarterectomy with patch angioplasty using a venous, bovine, or polyester patch between 2010 and 2020 at two high-volume medical centers were included in this retrospective analysis on largely prospectively collected data. Study endpoints included long-term ipsilateral transient ischemic attack or cerebrovascular accident, restenosis, reintervention, and all-cause mortality. Cox proportional hazard models were fitted to assess the effect of patch type to each outcome.
In total, 1481 CEAs were performed with a follow-up of 32 (13-65) months. Venous patch was used in 309 patients (20.9%), BPP in 1000 patients (67.5%), and polyester patch in 172 patients (11.6%). A preoperative symptomatic carotid artery stenosis of >50% was observed in 91.9% (n = 284) of the patients who received a venous patch, 92.1% (n = 921) of the patients who received BPP, and 90.7% (n = 156) of the patients who received a polyester patch (p = 0.799). Only in selected patients with an asymptomatic stenosis of >70% surgery was considered. Multivariable analyses showed no significant differences between the three patch types regarding long-term outcomes after adjusting for confounders.
In patients undergoing primary carotid endarterectomy, the use of venous, bovine pericardial, or polyester patches seems equally safe and durable in terms of comparability in long-term outcomes.
All patients who underwent primary carotid endarterectomy with patch angioplasty using a venous, bovine, or polyester patch between 2010 and 2020 at two high-volume medical centers were included in this retrospective analysis on largely prospectively collected data. Study endpoints included long-term ipsilateral transient ischemic attack or cerebrovascular accident, restenosis, reintervention, and all-cause mortality. Cox proportional hazard models were fitted to assess the effect of patch type to each outcome.
In total, 1481 CEAs were performed with a follow-up of 32 (13-65) months. Venous patch was used in 309 patients (20.9%), BPP in 1000 patients (67.5%), and polyester patch in 172 patients (11.6%). A preoperative symptomatic carotid artery stenosis of >50% was observed in 91.9% (n = 284) of the patients who received a venous patch, 92.1% (n = 921) of the patients who received BPP, and 90.7% (n = 156) of the patients who received a polyester patch (p = 0.799). Only in selected patients with an asymptomatic stenosis of >70% surgery was considered. Multivariable analyses showed no significant differences between the three patch types regarding long-term outcomes after adjusting for confounders.
In patients undergoing primary carotid endarterectomy, the use of venous, bovine pericardial, or polyester patches seems equally safe and durable in terms of comparability in long-term outcomes.
摘要：
背景：目前，用于颈动脉内膜切除术闭合的补片类型取决于手术外科医生的偏好.各种材料可用，包括自体静脉补片,牛心包片（BPP），和合成补丁。这项研究的目的是比较长期结果。
方法：所有接受原发性颈动脉内膜切除术并使用静脉补片血管成形术的患者，牛,本回顾性分析纳入了2010年至2020年在两个高容量医疗中心的聚酯贴片或聚酯贴片,其主要是前瞻性收集的数据.研究终点包括长期同侧短暂性脑缺血发作或脑血管意外，再狭窄,再干预,和全因死亡率。拟合Cox比例风险模型以评估贴片类型对每个结果的影响。
结果：总计，1481例CEA，随访32(13-65)个月。309例（20.9%）患者使用静脉贴剂，1000例患者的BPP（67.5%），和聚酯贴片172例（11.6%）。在91.9%（n=284）接受静脉补片的患者中，术前症状性颈动脉狭窄>50%，92.1%(n=921)接受BPP的患者，90.7%(n=156)接受聚酯贴剂的患者(p=0.799)。仅在选择的无症状性狭窄>70％的患者中考虑手术。多变量分析显示，在校正混杂因素后，三种斑块类型在长期结局方面没有显着差异。
结论：在接受原发性颈动脉内膜切除术的患者中，静脉的使用，牛心包,或聚酯贴片在长期结果的可比性方面似乎同样安全和耐用。
方法：所有接受原发性颈动脉内膜切除术并使用静脉补片血管成形术的患者，牛,本回顾性分析纳入了2010年至2020年在两个高容量医疗中心的聚酯贴片或聚酯贴片,其主要是前瞻性收集的数据.研究终点包括长期同侧短暂性脑缺血发作或脑血管意外，再狭窄,再干预,和全因死亡率。拟合Cox比例风险模型以评估贴片类型对每个结果的影响。
结果：总计，1481例CEA，随访32(13-65)个月。309例（20.9%）患者使用静脉贴剂，1000例患者的BPP（67.5%），和聚酯贴片172例（11.6%）。在91.9%（n=284）接受静脉补片的患者中，术前症状性颈动脉狭窄>50%，92.1%(n=921)接受BPP的患者，90.7%(n=156)接受聚酯贴剂的患者(p=0.799)。仅在选择的无症状性狭窄>70％的患者中考虑手术。多变量分析显示，在校正混杂因素后，三种斑块类型在长期结局方面没有显着差异。
结论：在接受原发性颈动脉内膜切除术的患者中，静脉的使用，牛心包,或聚酯贴片在长期结果的可比性方面似乎同样安全和耐用。
