Further evidence for the role of patch angioplasty (PA) over primary closure (PC) during carotid endarterectomy (CEA)

GALA Trial Collaborators, M. W. Twigg, R. Maiti, S. Lewis, M. J. Gough

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Objective: Despite concerns about data quality/poor trial design the 2009
Cochrane review concluded that PA (n = 1076) compared to PC (n =
932) reduces ipsilateral peri-operative stroke (IS) risk with trends towards
lower ‘any stroke’ (AS) and all-cause mortality (ACM) during CEA. This has
been investigated further in an unrelated RCT of 3438 CEA patients with
symptomatic or asymptomatic carotid stenosis.
Method: A 30-day independent neurological review assessed primary outcome
events. Risk ratios were calculated comparing PA (n = 1588) with PC (n = 1850:
985 conventional [PCC], 712 eversion [PCE], 153 unspecified [excluded]). PA
and PC data were then combined with Cochrane data.
Results: There were no differences in demographic data, ASA status, carotid
stenosis, comorbidities, and anti-thrombotic use between the groups. Operative
time was less for PC (81 v 107 min, p = 0·001). Odds ratios (± 95% confidence
intervals) for PA versus all PC suggested no benefit for PA (IS: 0·98, 0·66–1·45;
AS: 0·94, 0·66–1·33; ACM: 1·76, 0·97–3·17 [trend favouring PC]). However,
when PCC (IS: 0·82, 0·52–1·28; AS: 0·82, 0·52–1·23) and PCE (IS: 1·19,
0·70–2·03; AS: 1·26, 0·78–2·03) are considered separately, trends favour PA
over PCC and PCE over PA. Combining PA and PCC with Cochrane data
strengthens the role for PA (IS: 0·62, 0·42–0·90, p = 0·016; AS: 0·73, 0·52–1·02)
in stroke reduction although the trend for PCC reducing ACM (1·09, 0·6–1·95)
persists.
Conclusion: When data from a much larger study (with independent
neurological review) is combined with the Cochrane data, the role for PA
over PCC is stronger. However, PCE may offer similar benefits to PA with
shorter operating times
Original languageEnglish
Pages (from-to)11-11
Number of pages1
JournalBritish Journal of Surgery
Volume98
Issue numberS1
DOIs
Publication statusPublished - 1 Jan 2011
Event45th Annual Scientific Meeting of the Vascular-Society-of-Great-Britain-and-Ireland - Brighton
Duration: 24 Nov 201026 Nov 2010

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