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Carotid Endarterectomy with Primary Closure: Analysis of Outcomes and Review of the Literature.
MedLine Citation:
PMID:  21904262     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Despite abundant published support of patch angioplasty during carotid endarterectomy(CEA), primary-closure is still widely used. The reasons underlying the persistence of primary closure are not quite evident in the literature. OBJECTIVE:: To present our experience with primary closure in CEA, and provide a rationale for its persistent wide use. METHODS:: Medical records of all patients undergoing CEA by the senior author (RF) were retrospectively reviewed. Follow-up was supplemented with a telephone-interview and completion of a structured questionnaire. A review of the current literature was performed. RESULTS:: From 1998 to 2010, the senior author performed 111 CEAs. Average cross-clamp time was 33±11min. Postoperative complications included 1 non-ST-elevation myocardial infarction and two strokes. No deaths, cranial-nerve deficits, or acute re-occlusions were observed. After a mean follow-up of 64.6 months (7,170.6 case-months), there were 3 contralateral strokes and7 deaths. There were no ipsilateral strokes or restenoses >50%.Follow-up medication compliance was 94.6% for antiplatelet agents and 91.9% for statins. The outcomes of the current study were comparable to those of the available trials comparing patch angioplasty with primary closure. A careful evaluation of the literature revealed a number of reasons potentially explaining the persistent use of patch angioplasty. CONCLUSION:: In conjunction with contemporary medical management, primary closure during CEA may yield results comparable or superior to patch angioplasty. Advantages of primary closure include shorter cross-clamp times and elimination of graft-specific complications.
Georgios Zenonos; Ning Lin; Albert Kim; Jeong Eun Kim; Lance Governale; Robert Max Friedlander
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-01
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Neurological Surgery, University of Pittsburgh Medical Center; 2Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School; 3Department of Neurological Surgery, University of Miami School of Medicine.
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