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Online ISSN 1827-1847
Pedrini L., Dondi M. *, Cirelli M. R., Magagnoli A., Magnoni F., Santoro M. *, Pisano E.
From the Ospedale Maggiore C. A. Pizzardi - Bologna Unità Operativa di Chirurgia Vascolare Dipartimento Chirurgico
* Unità Operativa di Medicina Nucleare Dipartimento di Diagnostica per Immagini
Background. The application of an expanded patch after carotid endarterectomy (CEA) is recommended to reduce the incidence of restenosis. Most studies report treatment with saphenous or polytetrafluoroethylene patches (PTFE) because of thrombogenic response to polyester. This study evaluates the thrombogenicity of a polyester patch (FPD) passivated by fluoropolymer surface treatment which experimental studies have demonstrated as being less thrombogenic than other types of patches.
Methods. In this prospective and randomized study, 22 patients underwent CEA. Eleven received direct suture of the arteriotomy, and 11 received an FPD patch. The patient’s 111Indium-oxine labeled platelets were re-injected on the first postoperative day and scintigraphies were performed after 4, 24, and 48 hours.
Results. The results are reported as count ratio (CR) between the treated and the contralateral carotid artery at 4, 24 and 48 hours. In the direct suture group, the CR was 1.07±0.09, 1.2±0.27, and 1.197±0.50, respectively, whereas in the FPD-patch group the CR was 0.96±0.04, 1.08±0.09 and 1.216±0.24, respectively. A statistically significant difference in platelet adhesiveness was found only on evaluation at 4 hours. The relationship between CR and preoperative bleeding time was the only statistically significant parameter (r=0.5), which indicated a certain association with the pharmacological activity of the antiplatelet drug administered to the patients. At 6 months follow-up, 1 patient presented with restenosis greater than 60% and 1 patient with intimal hyperplasia 2 mm thick. The patients had abnormal blood coagulation values, but no relationship with common risk factors was found.
Conclusions. This study confirmed that the FPD patch is no more thrombogenic than a simple CEA; therefore, application of the patch can be recommended to reduce restenosis without any added thromboembolic risk. The feasibility of a multicenter trial was confirmed to show hypothetical differences between FPD-induced carotid thrombogenicity and long-term results.
language: English, Italian