Primary Arterial Closure After Carotid Endarterectomy Is Safe And Expeditious In Appropriately Selected Patients
Yazen Qumsiyeh, MD, Sammy Siada, DO, Rachel Dirks, PhD, Amna Ali, MD, Meelod Daneshvar, MD, Leigh Ann O'Banion, MD.
UCSF Fresno, Fresno, CA, USA.
OBJECTIVES: The benefit of carotid endarterectomy (CEA) in patients with symptomatic and asymptomatic carotid stenosis is well established. There is conflicting evidence on the benefit of patch angioplasty in decreasing post-operative arterial restenosis and ipsilateral stroke rate. This study aims to provide high-volume single institution data with long term follow up comparing restenosis rates, postoperative stroke, and stroke-free survival in patients undergoing CEA with patch angioplasty to those with primary closure. METHODS: A retrospective review of all patients undergoing CEA from 2011 to 2018 was performed. The primary endpoint was 30-day post-operative stroke rate. Secondary endpoints were significant ipsilateral restenosis (> 50% by imaging), late stroke, and death. Patients who underwent CEA with patch angioplasty were compared to patients who underwent primary closure. RESULTS: A total of 851 patients met inclusion criteria with a mean follow up of 741 ± 787 days. A majority (59%) were male and 614 (72%) were Caucasian. Mean age was 72 ± 9 years with 25% of patients older than age 80. CEA was performed for symptomatic disease in 306 (36%) patients. Patch angioplasty was performed in 574 (67%) patients while primary closure was performed in 277 (33%) of patients. Patients who underwent primary closure were more likely to be older (74 vs 72, p=0.001) and male (69% vs 31% p < 0.001) and had a higher incidence of diabetes mellitus (47% vs 39%, p=0.046) and ESRD (4% vs 2%, p = 0.015). Additionally, they were more likely to be symptomatic (39% vs 34%, p=0.024, and were less likely to be shunted (92% vs 98%, p <0.001) than the patch angioplasty cohort. Significant arterial restenosis was similar between the two groups (7% vs 8%, p=0.67). Operative time in patients who underwent primary closure was significantly shorter (87±28 vs 102±26 minutes, p<0.001). There were no differences in 30-day ipsilateral stroke rates (1% vs 1%, p=0.51) or stroke-free survival (Figure 1). CONCLUSIONS: Primary arterial closure after carotid endarterectomy is safe and expeditious in appropriately selected high-risk patients with similar post-op stroke rates and stroke-free survival compared to patch angioplasty. 
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