Duplex ultrasound findings and clinical outcomes of carotid restenosis after carotid endarterectomy

Medium-term restenosis after carotid endarterectomy by patch type: a single-centre retrospective study comparing biological with synthetic patch materials

INTRODUCTION

Carotid endarterectomy (CEA) with patch angioplasty is associated with lower restenosis rates compared with primary closure alone. However, evidence regarding patch-material superiority in the mitigation against neointimal hyperplasia and restenosis is limited. This retrospective observational study investigated medium-term restenosis rates between commercially available biological and synthetic carotid patches.

METHODS

All primary CEA with patch angioplasty performed between 2007 and 2019 at a single university hospital were identified from theatre records. Restenosis was defined using the European Society for Vascular Surgery duplex criteria, either moderate (50-69%, PSV >213cm/s) or critical (70-99%, PSV >274cm/s). Chi-square tests and Kaplan-Meier curves were used to compare restenosis rates between biological (bovine pericardium) and synthetic patches (Dacron, PFTE and polyester-urethane).

RESULTS

Overall, 127 CEAs were included in the restenosis analysis. Bovine pericardium was the patch material used most frequently (60%, n=75). Median follow-up with duplex was 40.0 months (range 0-144). Moderate restenosis was detected in 14 CEAs (11%) and critical restenosis in 10 (7.8%). Compared with synthetic material, bovine was significantly associated with >50% restenosis but not >70% (p=0.042 and p=0.197, respectively). However, Kaplan-Meier curves demonstrated similar rates of >50% and >70% restenosis between patch types at five years (p=0.081 and p=0.080, respectively). There was no significant difference in peri-operative complication rates between patch types.

CONCLUSIONS

These results indicate medium-term restenosis rates after CEA are similar between biological and synthetic patches. However, well-designed randomised control trials are required to definitively answer the question of which patch material is superior for carotid reconstruction.

Ultrasound Assessment of Plaque Characteristics to Predict Re-occlusion after Surgical Treatment of Internal Carotid Artery Occlusion

The purpose of this study was to explore the relationship between plaque characteristics and re-occlusion after surgical treatment of internal carotid artery occlusion (ICAO). From January 2015 to January 2021, 177 patients with ICAO underwent surgery. Eighty-five cases were included in the study, and in 13 of them, re-occlusion occurred within 6 mo after surgery treatment (13/85, 15.85%). The calcification at the base of the plaque was longer in the re-occlusion group than in the non-occlusion group (10.70 ± 4.22 mm vs. 7.15 ± 1.41 mm, p = 0.001). Multivariate regression analysis revealed that the length of calcification at the base of the plaque was an independent risk factor for postoperative re-occlusion (odds ratio [OR]: 1.414, 95% confidence interval [CI]: 1.078-1.855, p = 0.012). The cutoff value for the length of calcification at the base of the plaque predicting re-occlusion after ICAO was 8.5 mm (95% CI: 0.700-0.962, p = 0.001). The area under the receiver operating characteristic curve was 0.831. Sensitivity and specificity were 70% and 80.9%, respectively. These results indicate that pre-operative ultrasound examination of the length of calcification at the base of the plaque could predict re-occlusion after surgical treatment of ICAO.