Abstract

Aim: This study aimed to compare restenosis rates and perioperative outcomes following carotid endarterectomy (CEA) using Dacron patch angioplasty versus primary closure.
Material and Methods: This retrospective single-center study included patients who underwent primary CEA between January 2015 and December 2024. Of 944 screened patients, 776 met the eligibility criteria and were included in the final analysis. Patients were stratified according to arteriotomy closure technique into a patch closure group (n = 412) and a primary closure group (n = 364). Restenosis was assessed using duplex ultrasonography at 1, 6, and 12 months postoperatively. Moderate restenosis was defined as ≥ 50% luminal narrowing and severe restenosis as ≥ 70% luminal narrowing. Multivariable logistic regression analyses were performed to identify independent predictors of restenosis.
Results: The mean age of the study population was 67.2 years, and 550 patients (70.9%) were male. At 12 months, moderate restenosis was observed in 25 patients (6.1%) in the patch closure group and 53 patients (14.6%) in the primary closure group (p < 0.001), whereas severe restenosis occurred in 12 patients (2.9%) and 30 patients (8.2%), respectively (p < 0.001). In multivariable analysis, primary closure remained independently associated with both moderate restenosis (odds ratio [OR] 2.41, 95% confidence interval [CI] 1.42–4.09; p = 0.001) and severe restenosis (OR 2.58, 95% CI 1.28–5.18; p = 0.008). Rates of perioperative stroke, mortality, myocardial infarction, cranial nerve injury, and neck hematoma were comparable between the groups.
Conclusion: Patch angioplasty was associated with significantly lower rates of both moderate and severe restenosis following CEA without an increase in perioperative morbidity. Primary closure remained independently associated with restenosis after multivariable adjustment. These findings suggest that patch angioplasty may be associated with improved mid-term vessel patency after CEA.

Key words: Carotid endarterectomy, carotid restenosis, patch angioplasty, primary closure, carotid stenosis