Nationwide outcome analysis of primary carotid endarterectomy in symptomatic patients depending on closure technique and patch type.

Open AccessPublished:January 01, 2023DOI:
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      Current European guidelines recommend both eversion CEA and conventional CEA with routine patch closure, rather thar routine primary closure.
      Polyester and polytetrafluoroethylene (PTFE) have been used as patch material for a long time. More recently, bovine pericardium has been used, however there are few studies comparing long-term results between bovine pericardium and other patch types. The aim of this study was to investigate the short- and long-term results after CEA depending on surgical technique and patch material.


      Registry-based study on all primary CEAs (n=9205) performed for symptomatic carotid artery stenosis in Sweden from July 2008 to December 2019, cross linked with data from the Swedish stroke registry, Riksstroke, and chart review for evaluation of any events occurring during follow-up. Primary endpoint was ipsilateral stroke <30days. Secondary endpoints were reoperations due to neck haematoma and <30day ipsilateral stroke >30days, all stroke >30days and all-cause mortality.


      2495 patients had undergone eversion CEA and 6710 conventional CEA for symptomatic carotid stenosis. The most commonly used patch-material was Dacron (n=3921), followed by PTFE (n=588) and Bovine pericardium (n=413). 1788 patients underwent conventional CEA with primary closure.
      273 patients(3.0%) had a stroke<30days. Primary closure was associated with an increased risk of ipsilateral stroke and stroke or death <30days, OR 1.7(95%CI1.2-2.4), p=0.002; and 1.5(95% CI 1.2-2.0) respectively. During follow up (median 4.2 years), 592 patients had any form of stroke and 1492 died. There was no significant difference in long term risk of ipsilateral stroke, all stroke or death depending on surgical technique or patch material.


      There was an increased risk of ipsilateral stroke <30days in patients operated with primary closure compared to eversion-CEA and patch angioplasty. There was no difference between primary closure, different patch types or eversion after the perioperative phase.



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