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(Stroke. 2005;36:1814.)
© 2005 American Heart Association, Inc.

Cochrane Corner

Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure During Carotid Endarterectomy

R. Bond, MBBS, Dphil, FRCS; K. Rerkasem, MD, PhD; A.R. Naylor, MD, FRCS; A.F. Abu Rahma, MD, FRCS, FACS P.M. Rothwell, MD, PhD, FRCP

From the Stroke Prevention Research Unit (R.B., P.M.R.), University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK; the Vascular Group, Department of Surgery (K.R.), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; the Department of Vascular and Endovascular Surgery (A.R.N.), Leicester Royal Infirmary, Leicester, UK; and the Department of Surgery (A.F.A.R.), Robert C. Byrd Health Sciences Center of West Virginia University, Charleston.

Correspondence to Prof P.M. Rothwell, Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom. E-mail peter.rothwell@clneuro.ox.ac.uk

Section Editors: Geoffrey A. Donnan MD, FRACP Stephen M. Davis MD, FRACP

Key Words: angioplasty • endarterectomy, carotid

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Carotid endarterectomy has been shown to reduce the risk of stroke in selected patients with internal carotid artery stenosis. Carotid patch angioplasty performed during surgery may reduce the risk of restenosis, and consequently reduce the long-term risk of recurrent stroke. However, patching itself may be associated with complications.

	Objectives

 
We tested the hypothesis that carotid patch angioplasty resulted in a lower rate of significant arterial re-stenosis and therefore fewer recurrent strokes and stroke-related deaths without an increase in perioperative complications.

	Search Strategy

 
Two reviewers independently searched MEDLINE (1996 to April 2003), EMBASE (1980 to 2002), and Index to Scientific and Technical Proceedings (1980 to 1994). We also searched the Stroke Group trials register (April 2003), hand-searched 13 relevant journals up to 2002, and searched the reference lists of articles identified.

	Selection Criteria

 
Randomized and quasi-randomized trials comparing carotid patch angioplasty with primary closure in any patients undergoing carotid endarterectomy were included. Any type of patch material was eligible.

	Data Collection and Analysis

 
Thirty-day and long-term risks of stroke, death, ipsilateral stroke, re-stenosis (>50%), and wound complications were independently extracted by two reviewers (R.B., K.R.). Proportional risk reductions were calculated using the Peto method. Heterogeneity between trial results was tested using the standard ² test.

	Main Results

 
Seven trials involving 1193 patients undergoing 1281 operations were analyzed. Follow-up varied from hospital discharge to 5 years. Three trials used only vein patches, 1 trial used only PTFE patches, and 3 trials used both. The quality of trials was variable. Allocation concealment was only adequate in 4 trials. Clinical assessment was definitely blinded in only . . . [Full Text of this Article]