Carotid artery stenting: Clinical and procedural implications for near-occlusion stenosis

Ruíz-Salmerón, Rafael; Gamero, M.A.; Carrascosa, César; Pérez, Sergio; Araujo, D. de; Marcos, Francisco; Leiras, Sergio Rodríguez de; Vizcaíno, Manuel; Caparrós, C.; Izquierdo, Guillermo

doi:10.1016/j.nrleng.2013.10.014

Cited by 10 publications

(11 citation statements)

References 8 publications

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“…In our study, a complete patency of the SCNO was obtained in 83% of patients who underwent revascularization. These results seem to be lower than those previously reported with endovascular treatment (with a successful revascularization rate generally above 90%) [12][13][14] but similar to previous series of SCNO patients treated with endarterectomy [15,16]. The perioperative stroke or death rate was 5.7%, which is similar to the 5.4% observed for SCNO patients in the NASCET and ECST trials [2] but higher than the 2.4% recently described in the NEON study [7].…”

Section: Discussionsupporting

confidence: 66%

The risk of recurrent stroke at 24 months in patients with symptomatic carotid near‐occlusion: results from CAOS, a multicentre registry study

Garcia-Pastor

Gil‐Núñez

Ramírez-Moreno

et al. 2019

Euro J of Neurology

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Background and purpose The risk of recurrent stroke amongst patients with symptomatic carotid near‐occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24‐month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. Methods A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography‐confirmed SCNO were included. The primary end‐point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. Results The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24‐month cumulative incidence of the primary end‐point was 11.1% (95% confidence interval 5.8–16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log‐rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. Conclusions The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near‐occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.

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Section: Discussionsupporting

confidence: 66%

The risk of recurrent stroke at 24 months in patients with symptomatic carotid near‐occlusion: results from CAOS, a multicentre registry study

Garcia-Pastor

Gil‐Núñez

Ramírez-Moreno

et al. 2019

Euro J of Neurology

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“…In contrast, in studies with relatively higher complication rates, the reported complications tended to be major complications, such as major stroke, hyperperfusion syndrome, and death. [16][17][18][19]22 Our overall perioperative complication rate was 10.3%. The permanent morbidity and mortality rate was 4.2% in the group without collapse and 0% in the collapsed group.…”

Section: Discussionmentioning

confidence: 74%

“…For instance, consistent with our results, Son et al 17 reported an 8.7% perioperative hyperperfusion syndrome risk in patients with near-occlusion treated with CAS. Additionally, Ruiz-Salmeron et al 18 reported a 5.5% perioperative mortality rate related to intracranial hemorrhage secondary to hyperperfusion syndrome in patients with near-occlusion, which was higher than the rate in the group without near-occlusion (perioperative mortality rate related to hyperperfusion syndrome, 0.6%). However, from these studies, it is not possible to extract any data regarding the role of collapse in the near-occlusion group.…”

Section: Discussionmentioning

confidence: 97%

“…Nevertheless, CAS performed for near-occlusion constitutes 1.72% to 28.9% of all CAS procedures. 10 Many previous CAS studies have reported high technical success with near-occlusion treatment, [15][16][17][18][19][20][21] with perioperative complication rates ranging between 3.3% and 17.4%. Interestingly, in studies with low perioperative complication rates, most of the complications were TIA or minor strokes.…”

Section: Discussionmentioning

confidence: 99%

“…9,23 However, studies evaluating CAS in the setting of near-occlusion merged patients both with and without collapse into a single near-occlusion group without comparing these groups. [16][17][18][19]22 Hence, the actual perioperative complication rates of near-occlusions with and without collapse are unknown. To the best of our knowledge, Neves et al 7 are the only authors who reported outcomes of CAS specifically in patients with symptomatic near-occlusion with collapse.…”

Section: Discussionmentioning

confidence: 99%

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