Carotid Artery Stenting for Postcarotid Endarterectomy Restenosis is Safer than Redo Carotid Endarterectomy and Should be the Procedure of Choice

  • AbuRahma A
  • Abu-Halimah S
  • Stone P
  • et al.
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Abstract

Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients with post-carotid endarterectomy (CEA) stenosis. This study compares early and late clinical outcomes for both groups. Patient Population and Methods: This study analyzes 192 patients: 72 had reoperation (group A ) and 120 had CAS for post-CEA stenosis (group B). Patients were followed prospectively and had duplex ultrasounds at 1 month and every 6-12 months thereafter. The perioperative complications (perioperative stroke, myocardial infarction/death, cranial nerve injury) and 3-year end points were analyzed. A Kaplan-Meier life table analysis was used to estimate rates of freedom from stroke, stroke-free survival, ≥ 50% restenosis, and ≥ 80% restenosis. Results: Demographic/clinical characteristics were comparable for both groups, except for diabetes mellitus and coronary artery disease, which were significantly higher in group B. The indications for reoperations were transient ischemic attacks (TIA)/stroke in 72% for group A versus 57% for group B (p = .0328). The mean follow-up was 33 months (range 1-86) for group A and 24 months (range 1-78) for group B (p = .0026). The proportion of early (< 24 months) carotid restenosis prior to intervention was 51% in group A versus 27% in group B (p = .0013). The perioperative stroke rates were 3% and 1%, respectively (p = .5573). There were no myocardial infarctions or deaths in either group. The overall incidence of cranial nerve injury was 14% for group A versus 0% for group B (p < .0001). However, there was no statistical difference between the groups relating to permanent cranial nerve injury (1% versus 0%). The combined early and late stroke rates for groups A and B were 3% and 2%, respectively (p = .6347). The stroke-free rates at 1, 2, 3, and 4 years for groups A and B were 97%, 97%, 97%, and 97% and 98%, 98%, 98%, and 98%, respectively (p = .6490). The stroke-free survival rates were not significantly different. The rates of freedom from ≥ 50% restenosis at 1, 2, 3, and 4 years were 98%, 95%, 95%, and 95% for group A versus 95%, 89%, 80%, and 72% for group B (p = .0175). The freedom from ≥ 80% restenosis at 1, 2, 3, and 4 years for groups A and B was 98%, 97%, 97%, and 97% versus 99%, 96%, 92%, and 87%, respectively (p = .2281). Four patients (one symptomatic) in group B had reintervention for ≥ 80% restenosis. The rates of freedom from reintervention for groups A and B were 100%, 100%, 100%, and 100% versus 94%, 89%, 83%, and 79%, respectively (p = .0634). Conclusions: CAS is as safe as redo C EA. R edo C EA has a higher incidence of transient cranial nerve injury; however, CAS has a higher incidence of ≥ 50% in-stent restenosis.

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AbuRahma, A. F., Abu-Halimah, S., Stone, P. A., Hass, S. M., Mousa, A., Lough, E., … Emmett, M. (2010). Carotid Artery Stenting for Postcarotid Endarterectomy Restenosis is Safer than Redo Carotid Endarterectomy and Should be the Procedure of Choice. Journal of Vascular Surgery, 51(4), 1074. https://doi.org/10.1016/j.jvs.2010.01.023

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