Our Summary

This research paper looks at the safety and effectiveness of a surgical procedure called carotid patch angioplasty. This procedure is used to reduce the risk of strokes in people who are undergoing another surgery called carotid endarterectomy (CEA). This study is an update of previous reviews published in 1995 and 2008.

The researchers were particularly interested in whether carotid patch angioplasty could reduce the chances of the carotid artery narrowing again (restenosis) and therefore lower the risk of future strokes and stroke-related deaths. They also wanted to see if this method didn’t significantly increase surgical complications.

To find out, they looked at a number of previous studies, selecting trials that compared carotid patch angioplasty with a procedure known as primary closure in people undergoing CEA. They focused on outcomes such as stroke, death, significant complications related to surgery, and artery restenosis or occlusion (blockage) following the operation.

The researchers included 11 trials involving 2100 participants in total. They found that compared with primary closure, carotid patch angioplasty might not make a significant difference to reducing the risk of stroke during the perioperative period (the time around surgery), but it might reduce the risk of stroke in the long term. They also found that the procedure may reduce the risk of the operated artery narrowing again or becoming blocked soon after the operation and in the long term.

However, the evidence was not certain because the quality of the included studies was generally poor. Therefore, while the results suggest that carotid patch angioplasty could potentially be beneficial, more high-quality research is needed to confirm these findings.

FAQs

  1. What is carotid patch angioplasty and why is it performed?
  2. How does carotid patch angioplasty compare to primary closure in terms of reducing the risk of stroke and artery restenosis or occlusion?
  3. Why is there uncertainty in the study results about the effectiveness of carotid patch angioplasty?

Doctor’s Tip

A doctor may tell a patient considering carotid endarterectomy that carotid patch angioplasty may reduce the risk of future strokes and restenosis of the carotid artery. However, more high-quality research is needed to confirm these findings. It is important to discuss the potential benefits and risks of the procedure with your doctor before making a decision.

Suitable For

Patients who are typically recommended for carotid endarterectomy are those who have significant narrowing or blockage in their carotid arteries, which are the major blood vessels that supply blood to the brain. This narrowing, known as carotid artery stenosis, can increase the risk of stroke by reducing blood flow to the brain or by causing blood clots to form and break loose, leading to a stroke.

Patients who have had a previous stroke or transient ischemic attack (mini-stroke) related to carotid artery stenosis may also be recommended for carotid endarterectomy to reduce their risk of future strokes. Additionally, patients who have symptoms such as weakness or numbness on one side of the body, difficulty speaking, or vision problems that are caused by carotid artery stenosis may benefit from the procedure.

Ultimately, the decision to recommend carotid endarterectomy is based on the individual patient’s overall health, the severity of their carotid artery stenosis, and their risk factors for stroke. Patients should discuss the potential benefits and risks of the procedure with their healthcare provider to determine if carotid endarterectomy is the right treatment option for them.

Timeline

Before carotid endarterectomy, a patient may experience symptoms such as transient ischemic attacks (TIAs) or mini-strokes, which are warning signs of a potential stroke. They may also undergo imaging tests such as carotid ultrasound or angiography to assess the severity of the carotid artery blockage.

During carotid endarterectomy, the patient is placed under general anesthesia, and the surgeon makes an incision in the neck to access the carotid artery. The plaque causing the blockage is removed, and the artery may be repaired using a patch or a primary closure technique.

After carotid endarterectomy, the patient may experience some pain and swelling at the incision site, which can be managed with pain medication. They will need to rest and avoid strenuous activities for a period of time to allow for proper healing. Follow-up appointments with the surgeon may be scheduled to monitor the patient’s progress and assess any potential complications.

Overall, carotid endarterectomy is a relatively safe and effective procedure for reducing the risk of strokes in patients with carotid artery disease. It is important for patients to follow their healthcare provider’s recommendations for post-operative care to ensure a successful recovery.

What to Ask Your Doctor

  1. What are the potential benefits of undergoing carotid patch angioplasty in addition to carotid endarterectomy?

  2. What are the potential risks and complications associated with carotid patch angioplasty?

  3. How does carotid patch angioplasty compare to primary closure in terms of reducing the risk of stroke and artery restenosis?

  4. What is the success rate of carotid patch angioplasty in preventing future strokes and stroke-related deaths?

  5. What is the recovery process like after undergoing carotid patch angioplasty?

  6. Are there any specific factors that may make me a better or worse candidate for carotid patch angioplasty?

  7. How long will the effects of carotid patch angioplasty last in terms of preventing future strokes?

  8. Are there any lifestyle changes or medications that I should consider post-surgery to further reduce my risk of strokes?

  9. What follow-up appointments and monitoring will be necessary after undergoing carotid patch angioplasty?

  10. Are there any alternative treatments or procedures that I should consider for reducing my risk of stroke?

Reference

Authors: Orrapin S, Benyakorn T, Siribumrungwong B, Rerkasem K. Journal: Cochrane Database Syst Rev. 2022 Aug 3;8(8):CD000160. doi: 10.1002/14651858.CD000160.pub4. PMID: 35920689