Patch angioplasty versus primary closure for carotid endarterectomy

Kittipan Rerkasem; Peter M Rothwell

doi:10.1002/14651858.CD000160.pub3

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Analysis 1.1

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 1 Any stroke: fatal and non‐fatal.

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Analysis 1.2

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 2 Stroke‐related death.

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Analysis 1.3

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 3 Stroke ipsilateral to endarterectomy site.

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Analysis 1.4

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 4 Death from all causes.

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Analysis 1.5

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 5 Any stroke or death.

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Analysis 1.6

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 6 Occlusion of the artery operated on.

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Analysis 1.7

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 7 Rupture/haemorrhage of endarterectomy site.

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Analysis 1.8

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 8 Infection of the endarterectomy site.

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Analysis 1.9

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 9 Cranial nerve palsy.

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Analysis 1.10

Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 10 Complication with return to theatre.

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Analysis 2.1

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 1 Any stroke: fatal and non‐fatal.

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Analysis 2.2

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 2 Stroke‐related death.

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Analysis 2.3

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 3 Stroke ipsilateral to endarterectomy site.

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Analysis 2.4

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 4 Death from all causes.

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Analysis 2.5

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 5 Any stroke or death.

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Analysis 2.6

Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 6 Restenosis/occlusion of the operated artery.

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Table 1. Number of cases lost to follow up

Study	Total patients	Total operations	Patch lost at 30 days	Patch lost at end	Primary lost at 30 days	Primary lost at end	Number of exclusions	Crossover patch ‐ non	Crossover non ‐ patch
AbuRahma 1996	357	399	0	0	0	0	4	0	0
Al‐Rawi 2006l	315	338	0	7	0	8	10	Data not available	Data not available
Eikelboom 1988	126	129	0	10 patients lost to doppler FU but not clinical FU	0	7 to doppler FU but not clinical FU	0	3	3
Katz 1994	87	100	0	5	0	7	0	0	0
Lord 1989	123	140	0	0	0	0	4	Between 0 and 4	Between 0 and 4
Mannheim 2005	404	422	0	Data not available	0	Data not available	Data not available	0	0
Myers 1994	136 (109 after exclusion of 27 patients undergoing obligatory vein patching)	152 (122 analysed as 30 operations got obligatory vein patches)	0	6	0	8	30 operations underwent obligatory vein patch closure and 16 patients had both sides done (total 46)	0	0
Pratesi 1986	100	100	Data not available	Data not available	Data not available	Data not available	Data not available	Data not available	Data not available
Ranaboldo 1993	199	213	0	5	0	12	0	0	0 at 30‐day FU but 4 at 1‐year FU
Vleeschauwer 1987	126	174	0	Data not available	0	Data not available	0	0	0
FU: follow up

Table 1. Number of cases lost to follow up

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Comparison 1. Patch versus no patch: perioperative complications < 30 days

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Any stroke: fatal and non‐fatal Show forest plot	8	1769	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.57 [0.31, 1.03]

1.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.38 [0.08, 1.72]
1.2 Synthetic patch	3	837	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.23 [0.50, 3.07]
1.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.29 [0.11, 0.74]
2 Stroke‐related death Show forest plot	7	1441	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.47 [0.05, 4.56]

2.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.91 [0.06, 14.73]
2.2 Synthetic patch	2	509	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.13 [0.00, 6.46]
3 Stroke ipsilateral to endarterectomy site Show forest plot	7	1201	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.31 [0.15, 0.63]

3.1 Venous patch	3	349	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.39 [0.09, 1.75]
3.2 Synthetic patch	1	100	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.53 [0.05, 5.19]
3.3 Synthetic or venous patch	3	752	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.27 [0.11, 0.62]
4 Death from all causes Show forest plot	9	1869	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.62 [0.18, 2.09]

4.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.79 [0.18, 17.57]
4.2 Synthetic patch	3	837	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.14 [0.00, 7.15]
4.3 Synthetic or venous patch	3	686	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.48 [0.10, 2.24]
5 Any stroke or death Show forest plot	8	1769	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.58 [0.33, 1.01]

5.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.55 [0.13, 2.25]
5.2 Synthetic patch	3	837	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.10 [0.45, 2.69]
5.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.34 [0.15, 0.78]
6 Occlusion of the artery operated on Show forest plot	7	1435	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.18 [0.08, 0.41]

6.1 Venous patch	2	255	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.12 [0.01, 1.99]
6.2 Synthetic patch	2	428	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.33 [0.06, 1.95]
6.3 Synthetic or venous patch	3	752	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.16 [0.06, 0.42]
7 Rupture/haemorrhage of endarterectomy site Show forest plot	9	2031	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.24 [0.61, 2.54]

7.1 Venous patch	3	429	Peto Odds Ratio (Peto, Fixed, 95% CI)	6.86 [0.14, 346.63]
7.2 Synthetic patch	3	850	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.92 [0.39, 2.14]
7.3 Synthetic or venous patch	3	752	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.32 [0.56, 9.57]
8 Infection of the endarterectomy site Show forest plot	7	1563	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.38 [0.09, 1.54]

8.1 Venous patch	3	429	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
8.2 Synthetic patch	2	522	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.38 [0.09, 1.54]
8.3 Synthetic or venous patch	2	612	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
9 Cranial nerve palsy Show forest plot	4	1047	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.78 [0.36, 1.69]

9.1 Venous patch	1	126	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.77 [0.17, 3.50]
9.2 Synthetic patch	2	522	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.75 [0.24, 2.35]
9.3 Synthetic or venous patch	1	399	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.85 [0.19, 3.71]
10 Complication with return to theatre Show forest plot	7	1281	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.35 [0.16, 0.79]

10.1 Venous patch	3	429	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.98 [0.06, 15.64]
10.2 Synthetic patch	1	100	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.53 [0.05, 5.19]
10.3 Synthetic or venous patch	3	752	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.29 [0.12, 0.73]

Comparison 1. Patch versus no patch: perioperative complications < 30 days

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Comparison 2. Patch versus no patch: outcomes at end of follow up

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Any stroke: fatal and non‐fatal Show forest plot	7	1332	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.49 [0.27, 0.90]

1.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.42 [0.14, 1.30]
1.2 Synthetic patch	2	400	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.95 [0.59, 6.45]
1.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.25 [0.10, 0.62]
2 Stroke‐related death Show forest plot	6	1019	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.27 [0.05, 1.60]

2.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.46 [0.05, 4.52]
2.2 Synthetic patch	1	87	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.13 [0.01, 2.04]
3 Stroke ipsilateral to endarterectomy site Show forest plot	6	1141	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.32 [0.16, 0.63]

3.1 Venous patch	3	429	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.42 [0.12, 1.47]
3.2 Synthetic patch	1	100	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.53 [0.05, 5.19]
3.3 Synthetic or venous patch	2	612	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.25 [0.10, 0.62]
4 Death from all causes Show forest plot	7	1332	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.78 [0.54, 1.12]

4.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.80 [0.45, 1.42]
4.2 Synthetic patch	2	400	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.90 [0.39, 2.05]
4.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.69 [0.38, 1.26]
5 Any stroke or death Show forest plot	6	1019	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.59 [0.42, 0.84]

5.1 Venous patch	3	346	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.69 [0.40, 1.20]
5.2 Synthetic patch	1	87	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.62 [0.23, 1.66]
5.3 Synthetic or venous patch	2	586	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.51 [0.30, 0.86]
6 Restenosis/occlusion of the operated artery Show forest plot	8	1719	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.24 [0.17, 0.34]

6.1 Venous patch	3	429	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.34 [0.17, 0.66]
6.2 Synthetic patch	3	678	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.46 [0.22, 0.98]
6.3 Synthetic or venous patch	2	612	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.15 [0.09, 0.25]

Comparison 2. Patch versus no patch: outcomes at end of follow up

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