Patch angioplasty during carotid endarterectomy (CEA) is commonly used to treat carotid artery stenosis. Various patch materials are available, including venous, Dacron, bovine pericardium, and polytetrafluoroethylene. However, the choice of which patch to use is still a matter of debate. Autologous venous material has disadvantages such as wound-related problems and a prolonged intervention time. This is due to the harvesting of the vein. These limitations can be bypassed when synthetic or biological patches are used, which are immediately available. Therefore, the aim of our study was to compare the long-term outcomes in patients who received a CEA with either a bovine pericardial patch (BPP) or a Dacron patch.

A retrospective cohort study was conducted, including all patients who underwent CEA with a BPP or Dacron patch between January 2010 and December 2020 at our university medical center. The primary outcome was the occurrence of transient ischemic attack or cerebrovascular accident during follow-up and secondary outcomes included restenosis, reintervention, all-cause mortality, and patch infection. Cox proportional hazard models with stepwise backward elimination were utilized and hazard ratios (HR) with 95%-confidence interval (CI) were used to predict the above-mentioned long-term outcomes.

Four hundred and seventeen CEA patients were included. Two hundred and fifty-four (60.9%) patients received BPP and 163 received (39.1%) Dacron. The median follow-up time for the total group was 16 (IQR: 13-39) months. Postoperative hemorrhage (≤30 days) was significantly lower in the BPP cohort (0.5% BPP vs 5.6% Dacron; p=0.047). No other significant differences on short-term outcomes were found. Univariable cox regression analyses showed no significant differences between the effect estimates of Dacron and BPP on TIA/CVA (p=0.106), restenosis (p=0.211), reintervention (p=0.549), and all-cause mortality (p=0.158), shown in Figure 1. No significant differences were found after adjusting for confounders in the multivariable analyses: TIA/CVA, (p=0.939), restenosis (p=0.057), reintervention (p=0.193) and all-cause mortality (p=0.742)). Uni- and multivariable models are shown in table 1. Three patients with a Dacron patch had a graft infection compared to none of the patients in the group who received a BPP.

This large retrospective study showed comparable long-term outcomes of BPP and Dacron for CEA. No significant differences were shown regarding transient ischemic attack or cerebrovascular accident, restenosis, reintervention, and all-cause mortality. Both patches showed a low rate of long-term morbidity and mortality, making both options acceptable for CEA with patch angioplasty. Patch infection was rare and only three patients with a Dacron patch were affected. Future studies with a larger sample size should aim to rule out whether there is a difference in infection resistance between both patches.