Key result
Posterior transverse plication with patch angioplasty during CEA shows similar outcomes to patch alone.
Why the study?
Does adding posterior transverse plication before patch angioplasty during carotid endarterectomy safely correct internal carotid artery tortuosity without increasing neurologic events, restenosis, or mortality compared with Dacron patch closure alone?
Cohort (n=116)
Does adding posterior transverse plication before patch angioplasty during carotid endarterectomy safely correct internal carotid artery tortuosity without increasing neurologic events, restenosis, or mortality compared with Dacron patch closure alone?
Posterior transverse plication with patch angioplasty during carotid endarterectomy appears to be a safe surgical technique for correcting internal carotid artery tortuosity without arterial transection, demonstrating a complication profile comparable to standard patch closure alone.
Answers are grounded in this paper and cite their sources.
May support posterior plication safety in CEA for tortuosity; leaves open randomized confirmation of benefit versus patch alone.
OBJECTIVES: Excessive tortuosity of the internal carotid artery (ICA) can create a risk of kinking after carotid endarterectomy (CEA) with patch angioplasty. Posterior transverse plication (PTP) shortens and straightens the ICA without arterial transection or resection. This study reviewed our outcomes with PTP followed by patch angioplasty during CEA. METHODS: A retrospective cohort study identified patients who underwent CEA between 2006 and 2023. Patients treated with PTP and patch angioplasty (PTP+P) were compared with a contemporaneous cohort undergoing CEA with Dacron patch closure alone (DP) for the same atherosclerotic carotid disease. Early and long-term outcomes included neurologic events, restenosis, pseudoaneurysm formation, reintervention, and survival. RESULTS: Of 168 carotid interventions, 116 met inclusion criteria: 16 PTP+P and 100 DP. Patients in the PTP+P cohort were older and had higher rates of chronic renal insufficiency and coronary artery disease. There was no 30-day mortality or postoperative TIA/stroke in either cohort. During follow-up, no ipsilateral ischemic neurologic event occurred, and there was no significant difference in restenosis, pseudoaneurysm formation, reintervention, or overall survival. In adjusted analysis, increasing age was associated with worse survival, while PTP was not. CONCLUSIONS: In this small series, adding PTP during CEA before patch angioplasty appeared safe for correcting ICA tortuosity. The complication profile was similar to that of patients with straighter ICAs who underwent DP closure alone. A wide patch and intraoperative duplex ultrasound are advisable to prevent and detect technical narrowing at the plication site. MESHWORDS: Carotid endarterectomy; internal carotid artery tortuosity; posterior transverse plication; patch angioplasty; restenosis.
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Bikk et al. (2026) conducted a cohort in Atherosclerotic carotid disease with internal carotid artery tortuosity undergoing carotid endarterectomy (n=116). Posterior transverse plication (PTP) followed by patch angioplasty during carotid endarterectomy vs. Carotid endarterectomy with Dacron patch closure alone was evaluated on Early and long-term outcomes including 30-day mortality, postoperative TIA/stroke, ipsilateral ischemic neurologic events, restenosis, pseudoaneurysm formation, reintervention, and overall survival. Posterior transverse plication with patch angioplasty during CEA had 0% 30-day mortality or TIA/stroke and no difference in restenosis or survival vs patch alone.
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