Currently, there are various types of patches available on the market for carotid endarterectomy (CEA) with enlargement angioplasty, prosthetic and biological patches including bovine pericardial patches. Despite the increasing use of these biological patches, there is little data in the literature comparing the results of these two types of patch. The purpose of this study was to compare the short- and long-term results of bovine pericardium patches (BPP) with prosthetic patches (PP) in carotid thromboendarterectomy.
This study presents a retrospective analysis of all CEAs performed at Montpellier and Nîmes University Hospitals (France) in 2014 and 2015. Patients who underwent eversion were excluded. Pre-, per- and post-operative clinical and doppler ultrasound results were collected and analyzed. The primary endpoint was the comparison of the restenosis rate between the BPP and the PP group. Secondary endpoints were the analysis of restenosis risk factors (type of patch, gender, renal failure, smoking, diabetes, arterial hypertension, dyslipidemia and redo surgery were analyzed); the comparison of morbidity-mortality and infection between BPP and PP group and the comparison of morbidity-mortality between symptomatic and asymptomatic stenosis.
In total, 342 CEAs were performed, of which 168 (49%) with BPP and 174 (51%) with PP. Median follow-up was 30 months (IQR=24). The stroke rate at Day 30 was 3.22% and mortality at Day 30 was 1.86%. There was no significant difference between groups concerning anyone of the variables of interest. At the end of follow-up, the restenosis rate >50% was 7.31% (6.45% BPP group vs 8.22% PP group, p=.55). The severe restenosis rate (>70%) was 4.65% (5.16% BPP group vs 4.11% PP group, p=.79). The univariate analysis identified renal failure (Odds Ratio = 2.69) as the main risk factor. The postoperative infection rate was 1.17% (0.59% BPP group vs 1.75% PP group, p=.62).
The rates of stroke and post-operative death, bleeding, infection and restenosis are comparable between bovine pericardium patches and prosthetic patches in our study. The use of prosthetic or biological patches seems to deliver comparable outcomes. Further studies on larger samples are required.

Copyright © 2020. Published by Elsevier Inc.