Nine-year experience of bovine pericardium patch angioplasty during carotid endarterectomy

Purpose: This paper examines the clinical results of a 9-year experience in which the incidence of major (stroke and death) perioperative events and of recurrent stenosis (>60%) after carotid endarterectomy performed with a direct suture (DS) of the arteriotomy versus bovine pericardium patch angioplasty (BPPA) are compared. Methods and Materials: A total of 517 carotid endarterectomies were included in this nonrandomized study and were divided into two groups: group DS with 194 procedures and group BPPA with 323 procedures. All patients were entered in a follow-up program that ranged from 1 to 108 months (mean, 56.4 months) and included color duplex scan examinations at 1, 3, 6, and 12 months after surgery and every year thereafter. Results: The number of major (stroke and death) perioperative cerebrovascular accidents was eight (4.1%) in the DS Group and five (1.5%) in the BPPA group (P = .066). One death occurred in the DS group, and three occurred in the BPPA Group (P = .517). The four deaths in both groups were the result of strokes. No statistically significant difference was found in terms of early neurologic complications between the two groups. During the first year of follow-up study, the rate of restenosis >60% and occlusion was significantly lower in the BPPA group. Thereafter, the difference was not significant. Conclusion: In our experience, the use of BPPA or DS during carotid endarterectomy procedure does not cause a significantly different rate of perioperative major events (stroke or death) in the two groups. The incidence rate of restenosis is lower in the first year after surgery with BPPA, but in subsequent years, no significant difference in restenosis is seen. The early and late postoperative results with BPPA compare favorably with the reported data from literature with the use of other patch materials.