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Suroto NS, Rantam FA, Al Fauzi A, Widiyanti P, Turchan A, Pangaribuan V. Selection criteria for patch angioplasty material in carotid endarterectomy. Surg Neurol Int 2022; 13:362. [PMID: 36128094 PMCID: PMC9479565 DOI: 10.25259/sni_470_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Carotid endarterectomy (CEA) with patch angioplasty has been favored due to its lower reoccurrence of restenosis compared to primary CEA. There are multiple types of patch angioplasty material available. However, selection of patch material is based on uncertain criteria. The aim of this study is to determine the ideal criteria for selecting the best patch material for CEA.
Methods:
We conducted a comprehensive literature search for studies that describe the ideal criteria for selecting patch material for CEA. We compiled all of the criteria mentioned into one table and selecting the criteria which were most frequently mentioned with a simple scoring system.
Results:
A total of 65 studies out of 784 studies were assessed for its full-text eligibility. Thus, we found 23 studies that were eligible for analysis. There are 22 ideal criteria that were mentioned in the analyzed studies. We grouped these criteria into physical characteristics, safety, contribution to hemodynamic, contribution in tissue healing, economic aspect, and ability to prevent postsurgical complication. We proposed 10 ideal criteria for guiding vascular surgeon in selecting the best patch angioplasty material.
Conclusion:
To this day, no material has been discovered which meets all ten criteria. This study’s proposed ideal criteria serve as the foundation for the creation of the best patch angioplasty material.
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Affiliation(s)
- Nur Setiawan Suroto
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga,
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Fedik Abdul Rantam
- Stem Cell Research and Development Center, Universitas Airlangga,
- Department of Microbiology, Virology and Immunology Laboratory, Faculty of Veterinary Medicine, Universitas Airlangga,
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Prihartini Widiyanti
- Biomedical Engineering Study Program, Department of Physics, Faculty of Science and Technology, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
| | - Vega Pangaribuan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, / Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia,
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Martin GH, Saqib NU, Safi HJ. Treatment of an Infected, Bovine Pericardial Carotid Patch: Excision and Reconstruction with a Superficial Femoral Arterial Interposition Graft. Ann Vasc Surg 2020; 70:565.e1-565.e5. [PMID: 32768534 DOI: 10.1016/j.avsg.2020.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Carotid patch infection is a rare complication but one often associated with severe morbidity, including hemorrhage, stroke, cranial nerve injury, and mortality. We present a case of a gram-negative bacterial infection of a bovine pericardial carotid patch. Treatment ultimately required patch explantation and reconstruction with a femoral arterial interposition graft.
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Affiliation(s)
- Gordon H Martin
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX.
| | - Naveed U Saqib
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Hazim J Safi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
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Illuminati G, Calio' FG, D'Urso A, Ceccanei G, Pacilè MA. Management of Carotid Dacron Patch Infection: A Case Report Using Median Sternotomy for Proximal Common Carotid Artery Control and In Situ Polytetrafluoroethylene Grafting. Ann Vasc Surg 2009; 23:786.e1-5. [DOI: 10.1016/j.avsg.2009.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 07/23/2009] [Accepted: 08/18/2009] [Indexed: 11/15/2022]
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Abdelhamid MF, Wall ML, Vohra RK. Carotid Artery Pseudoaneurysm After Carotid Endarterectomy: Case Series and a Review of the Literature. Vasc Endovascular Surg 2009; 43:571-7. [DOI: 10.1177/1538574409334827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare complication with incidence less than 1%. There is a potential for rupture, embolization, thrombosis or compression of cranial nerves. Objective: We reviewed our experience and compare it to the literature to raise awareness of this rare though serious condition. It is crucial to treat these patients early to avoid the hazardous consequences. Methods: A review of the case records of patients who had CEA at University Hospital Birmingham (UHB) NHS Foundation Trust from 1990-2007, was undertaken. Information of patients including their aetiology, presenting features, treatment and results was collected. The English-language literature was searched using PubMed database for post CEA pseudoaneurysm. Results: Five patients developed post CEA PA. This represents 0.4% of the 1200 CEA performed at our hospital in the last 18 years. The timing of their presentation varied from three days to eight months after the original operation. All had patch reconstruction after CEA. Patches were intact at exploration of the PAs. There was one death and one stroke. The literature revealed 154 carotid PAs after CEA and two cases following carotid stenting 52 of these cases had infected PA. Patients with synthetic patches have the least incidence of infection. More than 80% had open surgery and 9% had endovascular repair. Conclusion: Post CEA surveillance is necessary to detect patients with PA early. Factors that favour infection must be avoided. Endovascular repair of carotid PA should be encouraged in specialised centres.
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Affiliation(s)
- Mohamed F. Abdelhamid
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom,
| | - Michael L. Wall
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom
| | - Rajiv K. Vohra
- Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, United Kingdom
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Bond R, Rerkasem K, Shearman CP, Rothwell PM. Time Trends in the Published Risks of Stroke and Death due to Endarterectomy for Symptomatic Carotid Stenosis. Cerebrovasc Dis 2004; 18:37-46. [PMID: 15159619 DOI: 10.1159/000078606] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Accepted: 01/06/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Large randomised trials performed in the 1980s and early 1990s showed that carotid endarterectomy (CEA) is beneficial for patients with recently symptomatic severe stenosis. Some surgeons have argued that the operative risk of stroke and death has fallen over the last decade due to refinements in operative technique, and that the indications for surgery should therefore now be broadened. Yet, studies of routinely collected data report higher operative mortality than in the trials, and surgical case series without independent post-operative assessment by a neurologist may not provide reliable data on stroke risk. METHODS We performed a systematic review of all studies published between 1994 and 2001 inclusive that which reported the risks of stroke and death for symptomatic carotid stenosis, and compared the reported risks and patient characteristics with those in the ECST and NASCET and with our previous review of studies published prior to 1995. Pooled estimates of the operative risk of stroke and death were obtained by Mantel-Haenszel meta-analysis. RESULTS Of 383 studies published between 1994 and 2001, only 45 reported operative risks for patients with symptomatic stenosis separately. The pooled operative risk of stroke and death reported in studies published by surgeons only (4.2%, 95% CI = 2.9-5.5, 34 studies) was significantly lower (p < 0.0001) than that in the ECST and NASCET combined (7.0%, 95% CI = 6.2-8.0), whereas the pooled risk reported in studies that involved neurologists was similar (6.5%, 95% CI = 4.3-8.7, 11 studies, p = 0.6). In contrast, operative mortality in ECST and NASCET was significantly lower than in other studies published between 1994 and 2001. By comparison with our previous review, when stratified according to involvement of neurologists, we found no evidence of a reduction in published risks of death or stroke and death due to CEA between 1985 and 2001. CONCLUSIONS There is no evidence of a systematic reduction over the last decade in the published risks of stroke and death due to CEA for symptomatic stenosis. Operative risks in studies with comparable outcome assessment are similar to ECST and NASCET. The surgical data from the large trials are still likely therefore to be applicable to routine clinical practice.
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Affiliation(s)
- R Bond
- Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Bond R, Rerkasem K, Rothwell PM. Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery. Stroke 2003; 34:2290-301. [PMID: 12920260 DOI: 10.1161/01.str.0000087785.01407.cc] [Citation(s) in RCA: 170] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Reliable data on the risk of carotid endarterectomy (CEA) in relation to clinical indication and timing of surgery are necessary to target CEA more effectively, to inform patients, to adjust risks for case mix, and to understand the mechanisms of operative stroke. METHODS We performed a systematic review of all studies published from 1980 to 2000 inclusive that reported the risk of stroke and death resulting from CEA. Pooled estimates of risk by type of presenting ischemic event and time since the last event were obtained by Mantel-Haenszel meta-analysis. RESULTS Of 383 published studies, only 103 stratified risk by indication. Although the operative risk for symptomatic stenosis overall was higher than for asymptomatic stenosis (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.45 to 1.81; P<0.00001; 59 studies), risk in patients with ocular events only tended to be lower than for asymptomatic stenosis (OR, 0.75, 95% CI, 0.50 to 1.14; 15 studies). Operative risk was the same for stroke and cerebral transient ischemic attack (OR, 1.16; 95% CI, 0.99 to 1.35; P=0.08; 23 studies) but higher for cerebral transient ischemic attack than for ocular events only (OR, 2.31; 95% CI, 1.72 to 3.12; P<0.00001; 19 studies) and for CEA for restenosis than primary surgery (OR, 1.95; 95% CI, 1.21 to 3.16; P=0.018; 6 studies). Urgent CEA for evolving symptoms had a much higher risk (19.2%, 95% CI, 10.7 to 27.8) than CEA for stable symptoms (OR, 3.9; 95% CI, 2.7 to 5.7; P<0.001; 13 studies), but there was no difference between early (<3 to 6 weeks) and late (>3 to 6 weeks) CEA for stroke in stable patients (OR, 1.13; 95% CI, 0.79 to 1.62; P=0.62; 11 studies). All observations were highly consistent across studies. CONCLUSIONS Risk of stroke and death resulting from CEA is highly dependent on the clinical indication. Audits of risk should be stratified accordingly, and patients should be informed of the risk that relates to their presenting event.
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Affiliation(s)
- R Bond
- Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK
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Rockman CB, Su WT, Domenig C, Lamparello PJ, Adelman MA, Jacobowitz GR, Pomposelli FB, Riles TS. Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy. J Vasc Surg 2003; 38:251-6. [PMID: 12891105 DOI: 10.1016/s0741-5214(03)00122-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Postoperative infection is one of the most dreaded complications associated with use of synthetic patches for carotid endarterectomy. Although polyester patches were used extensively for carotid patch angioplasty throughout the last decade, few reports detail cases of deep patch infection. We describe our experience with polyester patch infections after carotid endarterectomy. Patients and methods From January 1996 through December 2001 we treated polyester patch infections after carotid endarterectomy in 10 patients. RESULTS The interval from primary carotid endarterectomy to presentation with infection ranged from 11 days to 30 months. All patients underwent repeat operation that involved tissue debridement, excision of the polyester patch, and either interposition grafting or patch angioplasty with autologous vein. No perioperative stroke or death occurred; however, 1 patient had transient hoarseness, and in 1 patient a pseudoaneurysm developed that required additional surgical repair with a saphenous vein interposition graft. All patients remain well and free of infection with follow-up as long as 56 months. CONCLUSIONS Infection is a serious and rare complication of carotid patch angioplasty with polyester material. Nonetheless, it can be treated successfully with good results and acceptable morbidity with soft tissue debridement, prosthetic patch excision, and either patch angioplasty or interposition grafting with autologous vein.
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Affiliation(s)
- Caron B Rockman
- Division of Vascular Surgery, New York University Medical Center, 530 First Avenue, Suite 6F, New York, NY 10016, USA.
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O'Hara PJ, Hertzer NR, Mascha EJ, Krajewski LP, Clair DG, Ouriel K. A prospective, randomized study of saphenous vein patching versus synthetic patching during carotid endarterectomy. J Vasc Surg 2002; 35:324-32. [PMID: 11854731 DOI: 10.1067/mva.2002.120047] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was the determination of whether the choice of either autogenous saphenous vein (ASV) or synthetic material for patch angioplasty significantly influences the results after carotid endarterectomy (CEA). METHODS With Institutional Review Board approval, 195 patients (145 men and 50 women; mean age, 69 years) who underwent 207 CEAs were prospectively randomized to arteriotomy closure with ASV or synthetic patches from July 1996 to January 2000. One hundred and one patients (52%) were randomized to the ASV cohort, and 94 (48%) were randomized to the synthetic cohort. Aside from a slight gender imbalance (70% versus 79% male in the ASV versus the synthetic group), there were no clinically important differences in baseline demographic variables, risk factors, or surgical indications between the ASV and synthetic groups. RESULTS With all 207 randomized procedures on an intent-to-treat basis, there were two early (<30 days) postoperative deaths (1%). There were three perioperative strokes in the ASV cohort (3.0%) and two in the synthetic cohort (2.1%; P =.99). Two of these early strokes occurred in a subset of nine patients who received neither patch material, all after randomization but before CEA. Two patients in each group had late strokes. The cumulative freedom from stroke rate at 1 year (ASV, 94%; synthetic, 95%) was virtually identical for both cohorts. With the 125 patients who had at least one postoperative duplex scan, the incidence rate of recurrent (>or=60%) carotid stenosis was 4.8% (three of 62) for the ASV group and 6.3% (four of 63) for the synthetic group (P =.99). CONCLUSION No significant differences in the stroke, mortality, or restenosis rates were shown between the ASV and the synthetic cohorts. While conceding the power limitations inherent in this study, we conclude that CEA may be safely performed with similar early results with ASV or synthetic patches.
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Affiliation(s)
- Patrick J O'Hara
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
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Affiliation(s)
- Bruce A Perler
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287-8611, USA
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Jacobowitz GR, Kalish JA, Lee AM, Adelman MA, Riles TS, Landis R. Long-term follow-up of saphenous vein, internal jugular vein, and knitted Dacron patches for carotid artery endarterectomy. Ann Vasc Surg 2001; 15:281-7. [PMID: 11414077 DOI: 10.1007/s100160010086] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To determine whether choice of material used for patch closure following carotid artery endarterectomy (CAE) influences rates of early or late restenosis, stroke, and death, 274 consecutive CAEs were retrospectively reviewed. Saphenous vein (SV) was used in 159 (58.0%) procedures; everted, double-thickness jugular vein (JV) was used in 25 (9.1%); and knitted Dacron (KD) was used in 90 (32.9%). Primary closure was not used in this series. There were four perioperative strokes: two (1.3%) in SV, one (4%) in JV, and one (1.1%) in KD (NS). Follow-up was obtained on 263 (96%) operated arteries (mean 41.5 months). Duplex scan results were available for 236 (89.7%) of these arteries (mean follow-up time 33.7 months). There were three (2%) late strokes in SV and two (2.2%) in KD (NS). In long-term follow-up, one patient (0.7%) in SV and two (2.4%) in KD developed > 80% stenosis (NS). One patient (0.7%) in SV, one (5.3%) in JV, and one (1.2%) in KD had total occlusion of the operated vessel (NS). Three procedures (2.2%) in SV, 1 (5.3%) in JV, and 7 (8.5%) in KD demonstrated moderate stenosis (50-79%) (NS). Three-year follow-up shows that choice of patch material does not affect early or late stroke rate, stroke-related death rate, rate of high-grade (> 80%) restenosis, or rate of total occlusion. There is a higher incidence of moderate stenosis in KD. Although our results and a review of the literature do not indicate that these patients are at increased risk for symptoms or progression of stenosis, they should be followed by duplex scanning to ensure that this is the case.
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Affiliation(s)
- G R Jacobowitz
- Department of Surgery, New York University Medical Center, New York, NY, USA.
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Rizzo A, Hertzer NR, O'hara PJ, Krajewski LP, Beven EG. Dacron carotid patch infection: a report of eight cases. J Vasc Surg 2000; 32:602-6. [PMID: 10957670 DOI: 10.1067/mva.2000.107567] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
From 1995 through 1998, we encountered eight patients with infected Dacron patches after previous carotid endarterectomy. Two of the original operations had been done elsewhere, but the six patients who were collected from our own series represented 0.5% of the 1258 carotid endarterectomies we performed and 1.8% of the 340 synthetic carotid patches we applied without any comparable infections among another 918 patients who received either vein patch angioplasty (n = 843) or primary arteriotomy closure (n = 74) during the same 4-year study period. With a single exception ("no growth"), bacterial cultures that were obtained at the time of the eight reoperations revealed Staphylococcus (n = 4) or Streptococcus (n = 3) species. All of the infected Dacron patches were removed and were replaced with saphenous vein patches (n = 5) or interposition grafts (n = 3), after which appropriate oral (n = 2) or intravenous (n = 6) antibiotics were administered for 2 to 6 weeks. No postoperative deaths occurred, but there were 2 temporary cranial nerve injuries, 1 myocardial infarction, and 1 stroke that was related to preoperative angiography. A recurrent carotid infection has not developed in any of the eight patients during a mean follow-up interval of 16 months (range, 3-36 months).
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Affiliation(s)
- A Rizzo
- Department of Vascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Sternbach Y, Perler BA. The influence of female gender on the outcome of carotid endarterectomy: a challenge to the ACAS findings. Surgery 2000; 127:272-5. [PMID: 10715981 DOI: 10.1067/msy.2000.104120] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the Asymptomatic Carotid Endarterectomy Study (ACAS) the perioperative stroke and mortality rate was more than twice as high in women as in men, markedly reducing the long-term benefit of the operation; therefore the role of carotid endarterectomy (CEA) among women with asymptomatic carotid stenoses remains unclear. The current study was undertaken to further examine the influence of gender on the outcome of the operation. METHODS To control for all variables except gender, the records of all patients in an academic medical center who underwent elective CEA for asymptomatic disease, performed by one surgeon employing a uniform technique, over a 7-year interval were reviewed. RESULTS From January 1992 through September 1998, 156 CEA procedures for asymptomatic carotid stenoses were performed on 66 (44%) women (n = 68) and 83 (56%) men (n = 88). There were no differences in the prevalence of hypertension (69% vs 69%), diabetes mellitus (24% vs 19%), hyperlipidemia (47% vs 47%), or smoking (46% vs 60%) between women and men, respectively, although a history of angina (28% vs 13%, P < .05) and myocardial infarction (23% vs 6%, P < .01) was more common among men. The mean stenosis was 86% for men and 83% for women. The incidence of perioperative mortality, stroke, and transient ischemic events was 0%, 0.6%, and 0%, with no differences between women and men: 0% vs 0%, 0% vs 1.3%, and 0% vs 0%, respectively. CONCLUSIONS These findings indicate that female gender does not adversely influence the outcome of CEA when performed for treatment of asymptomatic disease. Gender should not be a consideration in the decision to perform CEA because of asymptomatic disease.
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Affiliation(s)
- Y Sternbach
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md. 21205, USA
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