This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Awad, I. A. Articles by Little, J. R. Search for Related Content PubMed PubMed Citation Articles by Awad, I. A. Articles by Little, J. R.

Stroke, Vol 20, 417-422, Copyright © 1989 by American Heart Association

ARTICLES

Patch angioplasty in carotid endarterectomy. Advantages, concerns, and controversies

IA Awad and JR Little
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio 44195- 5228.

There is much controversy in the literature regarding the precise role of patch angioplasty in carotid endarterectomy. Our report summarizes the theoretical and experimental considerations, including the hemodynamic effects and biologic behavior of the graft, associated with this technique. We present a detailed review of the literature regarding the clinical efficacy of patch angioplasty in carotid endarterectomy, including the early results, the late results, and the incidence and nature of carotid restenosis. We address concerns about the use of patch angioplasty, including the duration of cross-clamping, potential problems with the graft and suture-line disruption, and graft atherogenesis. We conclude that most recent literature indicates that patch angioplasty decreases acute complications (notably carotid occlusion) after carotid endarterectomy and prevents or delays carotid restenosis. As pressure increases to achieve a minimal rate of perioperative morbidity, many surgeons are expected to adopt patch angioplasty in more of their cases. However, in the absence of conclusive results from a prospective randomized study, opinion will continue to be divided regarding the routine versus the selective use of patch grafting in carotid endarterectomy. We present criteria for randomized trials of this technique.

This article has been cited by other articles:

				F. Koskas and E. Kieffer Carotid Eversion Endarterectomy: Should We Abandon the Standard Technique? Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 2000; 13(1): 115 - 126. [Abstract] [PDF]

				A. F. AbuRahma, P. A. Robinson, S. Saiedy, B. K. Richmond, and J. Khan Prospective Randomized Trial of Bilateral Carotid Endarterectomies : Primary Closure Versus Patching Stroke, June 1, 1999; 30(6): 1185 - 1189. [Abstract] [Full Text] [PDF]

				A. Byer, T. E. Quirke, P. C. Ritota, R. C. Keys, and B. Marcus Atherosclerotic Aneurysms Following Carotid Endarterectomy with Dacron Patch Angioplasty: An Unreported Complication: Three Case Reports Vascular and Endovascular Surgery, January 1, 1999; 33(1): 87 - 92. [Abstract] [PDF]

				J. Calaitges, A. Kashyap, and S. Annest Eversion Carotid Endarterectomy: A Safe, Advantageous Alternative to Conventional Carotid Endarterectomy: A Preliminary Report Vascular and Endovascular Surgery, September 1, 1996; 30(5): 381 - 385. [Abstract] [PDF]