A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy

Patch angioplasty during carotid endarterectomy is commonly used to treat symptomatic and asymptomatic carotid artery stenosis. The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short-...

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Veröffentlicht in:Journal of vascular surgery 2018-10, Vol.68 (4), p.1241-1256.e1
Hauptverfasser: Texakalidis, Pavlos, Giannopoulos, Stefanos, Charisis, Nektarios, Giannopoulos, Spyridon, Karasavvidis, Theofilos, Koullias, George, Jabbour, Pascal
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container_issue 4
container_start_page 1241
container_title Journal of vascular surgery
container_volume 68
creator Texakalidis, Pavlos
Giannopoulos, Stefanos
Charisis, Nektarios
Giannopoulos, Spyridon
Karasavvidis, Theofilos
Koullias, George
Jabbour, Pascal
description Patch angioplasty during carotid endarterectomy is commonly used to treat symptomatic and asymptomatic carotid artery stenosis. The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death. Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I2 = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I2 = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I2 = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I2 = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I2 = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I2 = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I2 = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I2 = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I2 = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I2 = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I2 = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I2 = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I2 = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I2 = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I2 = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I2 = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I2 = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%), and death (RR,
doi_str_mv 10.1016/j.jvs.2018.07.023
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The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death. Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I2 = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I2 = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I2 = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I2 = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I2 = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I2 = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I2 = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I2 = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I2 = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I2 = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I2 = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I2 = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I2 = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I2 = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I2 = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I2 = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I2 = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%), and death (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%). Closure of the carotid arteriotomy with any of the studied patch materials seems to be similar in terms of short- and long-term end points. However, additional randomized trials with adequate follow-up periods are needed to compare bovine pericardium patches with other patch materials.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2018.07.023</identifier><identifier>PMID: 30244928</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Animals ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - instrumentation ; Blood Vessel Prosthesis Implantation - mortality ; Bovine pericardium patch ; Carotid artery endarterectomy ; Carotid Stenosis - complications ; Carotid Stenosis - diagnostic imaging ; Carotid Stenosis - mortality ; Carotid Stenosis - surgery ; Cattle ; Dacron ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - methods ; Endarterectomy, Carotid - mortality ; Evidence-Based Medicine ; Female ; Heterografts ; Humans ; Male ; Middle Aged ; Odds Ratio ; Pericardium - transplantation ; Polyethylene Terephthalates ; Polytetrafluoroethylene ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Prosthesis Design ; PTFE ; Randomized Controlled Trials as Topic ; Risk Factors ; Synthetic patch ; Time Factors ; Treatment Outcome ; Venous patch</subject><ispartof>Journal of vascular surgery, 2018-10, Vol.68 (4), p.1241-1256.e1</ispartof><rights>2018 Society for Vascular Surgery</rights><rights>Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-89b6bba88b89bb64a2b77f1265b292eb11629eb77d69361e8022d1cc20a08e313</citedby><cites>FETCH-LOGICAL-c462t-89b6bba88b89bb64a2b77f1265b292eb11629eb77d69361e8022d1cc20a08e313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521418317919$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30244928$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Texakalidis, Pavlos</creatorcontrib><creatorcontrib>Giannopoulos, Stefanos</creatorcontrib><creatorcontrib>Charisis, Nektarios</creatorcontrib><creatorcontrib>Giannopoulos, Spyridon</creatorcontrib><creatorcontrib>Karasavvidis, Theofilos</creatorcontrib><creatorcontrib>Koullias, George</creatorcontrib><creatorcontrib>Jabbour, Pascal</creatorcontrib><title>A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Patch angioplasty during carotid endarterectomy is commonly used to treat symptomatic and asymptomatic carotid artery stenosis. The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death. Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I2 = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I2 = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I2 = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I2 = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I2 = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I2 = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I2 = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I2 = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I2 = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I2 = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I2 = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I2 = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I2 = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I2 = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I2 = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I2 = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I2 = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%), and death (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%). Closure of the carotid arteriotomy with any of the studied patch materials seems to be similar in terms of short- and long-term end points. However, additional randomized trials with adequate follow-up periods are needed to compare bovine pericardium patches with other patch materials.</description><subject>Aged</subject><subject>Animals</subject><subject>Blood Vessel Prosthesis</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - instrumentation</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Bovine pericardium patch</subject><subject>Carotid artery endarterectomy</subject><subject>Carotid Stenosis - complications</subject><subject>Carotid Stenosis - diagnostic imaging</subject><subject>Carotid Stenosis - mortality</subject><subject>Carotid Stenosis - surgery</subject><subject>Cattle</subject><subject>Dacron</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - methods</subject><subject>Endarterectomy, Carotid - mortality</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Heterografts</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Pericardium - transplantation</subject><subject>Polyethylene Terephthalates</subject><subject>Polytetrafluoroethylene</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Prosthesis Design</subject><subject>PTFE</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>Synthetic patch</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Venous patch</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1r3DAQhkVJaTZpf0AuQcdc7GpkryyTUwhpGwj00p6FPsaNlpXlSNqF7a-vlk16zGnE6HlfmIeQK2AtMBBfN-1mn1vOQLZsaBnvPpAVsHFohGTjGVmxoYdmzaE_Jxc5bxgDWMvhEznvGO_7kcsV2d_RgEU3etbbQ_aZxokmPbsY_F90tCSvt5naGBad_PyHmrj3M9IFk7c6Ob8LtNI0lmdMdNHFPtOgC55iU0y0UrF4R3F2OtUPtCWGw2fycaoEfnmdl-T3t4df9z-ap5_fH-_vnhrbC14aORphjJbS1JcRveZmGCbgYm34yNEACD5i3TkxdgJQMs4dWMuZZhI76C7Jzal3SfFlh7mo4LPF7VbPGHdZcQAYeiH6saJwQm2KOSec1JJ80OmggKmjbrVRVbc66lZsUFV3zVy_1u9MQPc_8ea3ArcnAOuRe49JZetxtuj80YRy0b9T_w-jM5JT</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Texakalidis, Pavlos</creator><creator>Giannopoulos, Stefanos</creator><creator>Charisis, Nektarios</creator><creator>Giannopoulos, Spyridon</creator><creator>Karasavvidis, Theofilos</creator><creator>Koullias, George</creator><creator>Jabbour, Pascal</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy</title><author>Texakalidis, Pavlos ; 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The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes. This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I2 statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death. Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I2 = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I2 = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I2 = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I2 = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I2 = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I2 = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I2 = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I2 = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I2 = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I2 = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I2 = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I2 = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I2 = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I2 = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I2 = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I2 = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I2 = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%), and death (RR, 4.01; 95% CI, 0.46-34.85; I2 = 0%). Closure of the carotid arteriotomy with any of the studied patch materials seems to be similar in terms of short- and long-term end points. However, additional randomized trials with adequate follow-up periods are needed to compare bovine pericardium patches with other patch materials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30244928</pmid><doi>10.1016/j.jvs.2018.07.023</doi><oa>free_for_read</oa></addata></record>
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ispartof Journal of vascular surgery, 2018-10, Vol.68 (4), p.1241-1256.e1
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1097-6809
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source MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals
subjects Aged
Animals
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - instrumentation
Blood Vessel Prosthesis Implantation - mortality
Bovine pericardium patch
Carotid artery endarterectomy
Carotid Stenosis - complications
Carotid Stenosis - diagnostic imaging
Carotid Stenosis - mortality
Carotid Stenosis - surgery
Cattle
Dacron
Endarterectomy, Carotid - adverse effects
Endarterectomy, Carotid - methods
Endarterectomy, Carotid - mortality
Evidence-Based Medicine
Female
Heterografts
Humans
Male
Middle Aged
Odds Ratio
Pericardium - transplantation
Polyethylene Terephthalates
Polytetrafluoroethylene
Postoperative Complications - etiology
Postoperative Complications - mortality
Prosthesis Design
PTFE
Randomized Controlled Trials as Topic
Risk Factors
Synthetic patch
Time Factors
Treatment Outcome
Venous patch
title A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy
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