Abstract
A comprehensive retrospective study in Japan has shed new light on the effectiveness of carotid endarterectomy (CEA) with patch graft closure in preventing restenosis and ipsilateral stroke over a decade. This article analyzes the research conducted by Toshiyuki Okazaki and colleagues, outlining the 5- and 10-year follow-up results while discussing the implications for surgical practice and patient outcomes.
Introduction
Stroke prevention has long been a central concern in cardiovascular medicine, particularly in managing cervical artery stenosis. Carotid endarterectomy (CEA) is a surgical procedure designed to reduce the risk of stroke by removing plaque from the carotid artery. In Japan, the traditional approach to CEA has been primary closure after plaque removal. However, recent evidence suggests that patch graft closure may provide better outcomes, notably in reducing the incidence of restenosis and ipsilateral stroke. A single-center retrospective study, as reported in the journal Neurologia medico-chirurgica, evaluated the long-term impact of CEA with patch graft closure, presenting crucial insights into the procedure’s durability over five and ten years.
Background
Carotid artery stenosis, characterized by the narrowing of the carotid arteries due to atherosclerosis, poses a significant risk for ischemic stroke. While carotid artery stenting (CAS) has grown in popularity worldwide, CEA with patch graft closure—a surgical method that covers the artery opening with a patch following plaque removal—has shown promising outcomes in minimizing restenosis rates.
Methods
In this study (Okazaki et al., 2019), the outcomes of 134 patients who underwent CEA with patch graft closure at Tokushima University were assessed retrospectively. Out of these, 102 procedures in 97 patients were followed up for five years, and 66 procedures in 61 patients for ten years post-operation. Restenosis was defined as more than 50% luminal narrowing at the site of endarterectomy.
Main Findings
The restenosis rate over five years was just 1.0%, with only one patient experiencing a minor stroke 58 months post-CEA. Over ten years, the restenosis rate slightly increased to 6.1%, inclusive of the cases previously identified at the 5-year mark. Minor stroke occurred in 6.1% of patients over the 10-year period.
Discussion
The low incidence of restenosis and stroke suggests a significant protective benefit of CEA with patch graft closure. Such findings are imperative as they validate the surgical technique’s efficacy beyond the short-term postoperative window. The authors contrasted these results with the restenosis rates post-CAS, reinforcing the potential advantages of CEA in specific patient cohorts. The choice of patch materials and the technique’s execution have been central discussion points in the literature, impacting long-term outcomes.
Clinical Implications
This study reaffirms the role of patched CEA as a durable surgical intervention for carotid artery stenosis. Physicians and surgeons may consider the long-term benefits of patch graft closure in their clinical decision-making, especially given the growing prevalence of CAS.
Limitations and Future Research
As a single-center study with its inherent limitations, further multicenter, randomized trials are needed to establish these findings more robustly. Additionally, the study calls for continuous innovation in both surgical techniques and patch materials to minimize restenosis further.
Conclusions
CEA with patch graft closure demonstrates a longstanding protective effect against restenosis and stroke in patients with carotid artery stenosis. The study by Okazaki et al. forms a solid evidence base supporting the surgical technique, indicating a potential preference over CAS in specific clinical scenarios.
Keywords
1. Carotid endarterectomy outcomes
2. Patch graft closure CEA
3. Long-term CEA efficacy
4. Cervical artery stenosis treatment
5. Restenosis post-carotid surgery
References
1. Okazaki, T., Kanematsu, Y., Shimada, K., et al. (2019). A Single-center Retrospective Study with 5- and 10-year Follow-up of Carotid Endarterectomy with Patch Graft. Neurologia medico-chirurgica, 59(6), 231-237. DOI: 10.2176/nmc.oa.2018-0309
2. North American Symptomatic Carotid Endarterectomy Trial. (1991). Stroke, 22, 711–720. DOI: 10.1161/01.STR.22.6.711
3. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). JAMA, 273, 1421–1428. DOI: 10.1001/jama.273.18.1421
4. European Carotid Surgery Trialists’ Collaborative Group. (1998). Lancet, 351, 1379–1387. DOI: 10.1016/S0140-6736(97)09292-1
5. Halliday, A., Harrison, M., Hayter, E., et al. (2010). Lancet, 376, 1074–1084. DOI: 10.1016/S0140-6736(10)61197-X
The digital object identifier (DOI) for the study referenced in this article is: 10.2176/nmc.oa.2018-0309