Prospective randomized trial of ACUSEAL (Gore-Tex) versus Hemashield-Finesse patching during carotid endarterectomy: Early results

Stone

Elmore

et al. 2008

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Section: Resultssupporting

confidence: 41%

mentioning

confidence: 99%

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Prospective randomized trial of ACUSEAL (Gore-Tex) vs Finesse (Hemashield) patching during carotid endarterectomy: Long-term outcome

Stone

Elmore

et al. 2008

Self Cite

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Table I summarizes some of these results. Finally, in our practice, and using only patients (1159 CEAs) who were part of several CEA randomized trials, which were done under general anesthesia with routine shunting (carotid argyle shunt), we reported a stroke rate of 1% to 2% based on the type of patch used. [10][11][12][13][14] …”

Section: Routine Carotid Shuntingmentioning

confidence: 99%

Shunting during carotid endarterectomy

Mousa

Stone

2011

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115

“…21,23,25,30,31,40,54 Unfortunately, our experience with the use of bovine pericardial patching has been limited, however, several recently published studies have confirmed a favorable clinical outcome using this patch after CEA. [55][56][57] Biasi et al 55 reported on their 9-year experience with the use of bovine pericardial patch angioplasty during CEA.…”

Section: Cea With Primary Closure Vs Patch Closurementioning

confidence: 99%

Processes of care for carotid endarterectomy: Surgical and anesthesia considerations

2009

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There are still some vascular surgeons who do not use carotid patching routinely in all patients undergoing CEA, however, based on the data presented in this review, there is Level 1 evidence to support the routine use of carotid patching. Meanwhile, there is no Level 1 evidence to support selective patching for CEA, however a Grade D recommendation may be used to recommend that primary closure can be safely practiced in a large ICA (>6mm). A meta-analysis/systemic review of well-conducted prospective randomized trials (Level 1 evidence) concluded that there was no difference in stroke/death rates between conventional CEA with patch closure and eversion CEA. The incidence of significant restenosis with eversion CEA is also similar to CEA with patch closure, however eversion CEA had a lower restenosis rate than patients undergoing CEA with primary closure. Prior to the GALA trial, there was insufficient evidence from randomized clinical trials comparing CEA under local anesthesia versus general anesthesia to support the superiority of either technique in reducing major perioperative events, i.e. stroke, MI, or death. However, the GALA trial concluded that the perioperative stroke/MI and death rates were equivalent in both techniques.