Editor's Choice – Network Meta-Analysis of Carotid Endarterectomy Closure Techniques

ObjectiveThere is discordance between reviews comparing eversion endarterectomy (EvE) with conventional carotid (CEA) mostly because under this term various “closure” techniques are included, from direct closure to a wide spectrum of patches different materials.Data sourcesMEDLINE (via PubMed) and SCOPUS.Review methodsThis was systematic review the Medline SCOPUS databases for randomised controlled trials (RCTs) CEA techniques. Network meta-analysis (NMA) performed frequentist approach. The primary secondary outcome measures were 30 day combined stroke death rate late restenosis rate, respectively.ResultsTwenty-three RCTs finally included in NMA total 4440 patients randomised, representing seven (primary closure, n = 753; EvE, 431; vein patch 973; polytetrafluoroethylene [PTFE] patch, 948; Dacron 828; bovine pericardium 249; polyurethane 258). showed that EvE had decreased vs. all other methods arterial exception PTFE patching. Additionally, associated lowest after CEA. significantly superior regard restenosis, prediction intervals (PIs) lying completely on beneficial side (risk ratio 0.06; PI 0.01–0.58) increasing confidence comparison. Rare catastrophic complications blow out or synthetic infection reported 0.2% (n 9/4 400) no comparisons made.ConclusionEvE patching lower incidence both short undesired outcomes following seems represent best choice compared These results may support vascular surgeon's technique/patch material. There materials. MEDLINE SCOPUS. This respectively. Twenty-three made.