Stroke: patch angioplasty decreases stroke at 30 days.

Clinical bottom line (level 1a)

  1. Patients undergoing carotid endarterectomy who are given patch angioplasty are less likely to have a stroke at 30 days, than those given primary closure.
  2. Patients who are given patch angioplasty have no clear difference in death at 30 days, than those given primary closure.
  3. There is no clear difference in stroke or death at 30 days.
Counsell et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of unconfounded randomised trials of
  • Patients: undergoing carotid endarterectomy
  • Intervention: routine patch angioplasty compared with primary closure
  • Outcome: stroke or death within 30 days


    • Articles found in ? using Cochrane Stroke Group trials register, MEDLINE, EMBASE, Index to Scientific and Technical Proceedings, from 1966 (search terms: carotid endarterectomy, carotid surgery ) and hand searched Annals of Surgery (1981-1995), British Journal of Surgery (1985-1995), European Journal of Vascular and Endovascular Surgery (1987-1995) and World Journal of Surgery (1978-1995).

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: No intention-to-treat analysis possible.

    Six trials involving 794 patients.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    stroke 30 days /
    (5.4%)    		 0.38
    (0.15 to 0.97)     		31
    (22 to 651)
    death 30 days /
    (12.4%)    		 0.93
    (0.18 to 4.65)     		130
    (NNT = 10 to infinity;
    NNH = 4 to infinity)
    stroke or death 30 days /
    (15.7%)    		 0.47
    (0.20 to 1.13)     		13
    (NNT = 8 to infinity;
    NNH = 59 to infinity)

    Citation

    1. Counsell C, Salinas C, Warlow C, et al: Patch angioplasty versus primary closure for carotid endarterectomy. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient undergoing carotid endarterectomy
    Intervention or Exposure patch angioplasty
    Comparison primary closure
    Outcome death or stroke within 30 days