To evaluate the perioperative outcomes and the immediate increases in size after patch closure, 140
carotid endarterectomies were randomized into one of three groups: direct no-patch closure, saphenous vein patch closure, and
polytetrafluoroethylene patch closure. Seven patients (4.4%) experienced signs of
cerebral ischemia in the immediate postoperative period. In three cases this was transient and reversible. In the other four reexploration was undertaken and
carotid thrombosis was corrected by
thrombectomy. The condition of one of these patients deteriorated to a permanent
stroke, whereas the other patients made a complete recovery. Neurologic complications were more frequent in the no-patch group, but the differences between the groups were not significant. The incidence of perioperative internal
carotid stenosis, aneurysmal dilatation, and other morphologic abnormalities was assessed in 131 intravenous digital subtraction angiograms taken before the patient was discharged from the hospital. Eight (17.0%) of the
endarterectomies in the no-patch group were narrowed by 30% to 50% diameter
stenosis, whereas none of the patched arteries had more than 30%
stenosis. In contrast, dilatation of the common or internal carotid artery to more than twice the measured diameter was absent in non-patched arteries but was present in seven (17.0%) saphenous patch closures and four (9.23%)
polytetrafluoroethylene patch closures. We conclude that patch closure after
carotid endarterectomy is less likely to cause
stenosis in the
perioperative period. Poly-
tetrafluoroethylene patches resist dilatation better than do saphenous vein patches and are less likely to become aneurysmal.