Propensity-Matched Comparison for Carotid Artery Stenting in Primary Stenosis Versus after Carotid Endarterectomy Restenosis

Kahlberg, Andrea; Ardita, Vincenzo; Spertino, Andrea; Mascia, Daniele; Bertoglio, Luca; Baccellieri, Domenico; Lembo, Rosalba; Melissano, Germano; Chiesa, Roberto

doi:10.1016/j.avsg.2020.06.063

Cited by 3 publications

(4 citation statements)

References 31 publications

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“…Most studies have separately analyzed the short- and mid-/long-term outcomes of carotid artery stenting (CAS) for atherosclerosis and post-surgical restenosis [ 19 , 20 ], but we found eight studies that did so comparatively [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The two main indicators of the short-term success of CAS are the rate of new or recurrent neurological events and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…The same rates for post-surgical ICA restenosis stenting range from 0% to 18% and 0% to 2%, respectively [ 20 ]. In three of the eight comparative studies, peri- and postprocedural neurological complications were more frequent in patients undergoing stenting for atherosclerotic ICA stenoses [ 22 , 23 , 24 ]. The other five studies showed no significant difference in neurological events within 30 days after stenting between the two etiological groups [ 21 , 25 , 26 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…The other five studies showed no significant difference in neurological events within 30 days after stenting between the two etiological groups [ 21 , 25 , 26 , 27 , 28 ]. The etiology of ICA lesions had no effect on CAS 30-day mortality in any of the comparative studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. However, to the best of our knowledge, no study has specifically investigated the outcome of CAS in distal ICA lesions.…”

Section: Discussionmentioning

confidence: 99%

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Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Nguyen

Bérczi

Nyárády

et al. 2022

JCM

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The aim was to evaluate the outcome of stenting in patients with isolated distal internal carotid artery (ICA) stenosis or post-surgical restenosis, as no data are currently available in the literature. Sixty-six patients (men, N = 53; median age: 66 [IQR, 61–73] years) with ≥ 50% distal ICA (re)stenosis were included in this single-center retrospective study. The narrowest part of the (re)stenosis was at least 20 mm from the bifurcation in all patients. Patients were divided into two etiological groups, atherosclerotic (AS, N = 40) and post-surgical restenotic (RES, N = 26). Postprocedural neurological events were observed in two patients (5%) in the AS group and in two patients (7.7%) in the RES group. The median follow-up time was 40 (IQR, 18–86) months. Three patients (7.5%) in the AS group had an in-stent restenosis (ISR) ≥ 50%, but none in the RES group. Three patients (7.5%) in the AS group and seven patients (26.9%) in the RES group died. None of the deaths in the RES group were directly related to stenting itself. The early neurological complication rate of stenting due to distal ICA (re)stenoses is acceptable. However, the mid-term mortality rate of stenting for distal ICA post-surgical restenoses is high, indicating the vulnerability of this subgroup.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Nguyen

Bérczi

Nyárády

et al. 2022

JCM

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“…So, the application of atropine during CAS for recurrent carotid stenosis after prior eversion CEA might not be necessary. 34,35 Following the publication of the encouraging results of the aforementioned trials, [13][14][15][16] a number of operators (including vascular surgeons, interventional radiologists, and cardiologists) moved to the belief that micromesh stents may ensure better results, especially in symptomatic patients or in case of "high-risk" plaques. Following this trend, our experience confirms that selective use of Roadsaver/Casper stents is often preferred in patients considered at increased risk for periprocedural embolic events.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents

et al. 2021

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Purpose: To evaluate patients characteristics, procedural details, perioperative outcomes, and midterm results of carotid artery stenting (CAS) performed with the Roadsaver/Casper stent (Terumo Corp, Tokyo, Japan) as compared to concurrent patients treated with other commercially available carotid stents. Materials and Methods: This is a single-center, retrospective, nonrandomized study including 200 consecutive patients who underwent a total of 205 elective CAS procedures due to severe internal carotid artery stenosis between April 2015 and December 2018. Procedural data and outcomes for patients treated with the Roadsaver/Casper stent implantation (100 procedures, in 97 patients) vs first-generation carotid stents implantations (90 procedures, in 88 patients) were compared. Fifteen patients were treated with CGuard carotid stent (InspireMD, Tel Aviv, Israel), and outcomes were reported separately. Primary endpoints were the occurrence of major adverse cerebrovascular events (MACE), including death, ipsilateral stroke, and transitory ischemic attack (TIA). Secondary endpoints were the rate of intrastent stenosis, the need for reintervention, and the occurrence of adverse cardiovascular events, including myocardial infarction, arrhythmias, and need for inotropic support. Results: No difference in demographics and preoperative risk factors were observed between patients treated with and without the Roadsaver/Casper stent. The mean procedure time was shorter in the Roadsaver/Casper group (40.7±16.9 vs 49.4±27.3 minutes; p=0.008), while radial percutaneous access was more frequent (24% vs 5%; p<0.001). The rate of stroke/TIA/death at 30 days was 3% in the Roadsaver group vs 1% in the first-generation stent group (p=0.623). The primary patencyrate was 100% and 93.4% at 1- and 3-year of follow-up in the Roadsaver/Casper groupand 99% and 94.3% in the other stent group, respectively (p=0.95). Conclusions: In this real-world cohort of patients undergoing CAS, the Roadsaver/Casper stent was used to treat more symptomatic and vulnerable carotid plaques as compared to other carotid stents. Nevertheless, patients treated with this low-profile dual-layer micromesh stent showed low events rates at both 30 days and follow-up, similar to that observed for other stents.

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Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting

Szegedi,

Potvorszki,

Mészáros

et al. 2023

Front. Neurol.

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IntroductionRedo carotid endarterectomy (CEA) and carotid stenting (CAS) are often performed when there is evidence of post-procedural restenosis. The incidence of restenosis after carotid reconstruction is not negligible, ranging from 5 to 33%. The diagnosis of significant internal carotid artery (ICA) restenosis is usually based on duplex ultrasound (US) criteria, mostly on peak-systolic flow velocity (PSV). However, there have been no generally accepted duplex US criteria for carotid restenosis after CAS or CEA.MethodsIn this systematic review, the PubMed/ Medline and Scopus databases were screened to find trials that reported duplex US criteria for significant restenosis after CEA and/or CAS. Only those reports were analyzed in which the restenoses were also assessed by CT/MR or digital subtraction angiography as comparators for duplex US.ResultsFourteen studies met the predetermined search criteria and were included in this review. In most studies, PSV thresholds for significant in-stent ICA restenosis after CAS were higher than those for significant stenosis in non-procedurally treated (native) ICA. Many fewer studies investigated the US criteria for ICA restenosis after CEA. Despite the heterogeneous data, there is a consensus to use higher flow velocity thresholds for assessment of stenosis in stented ICA than in native ICA; however, there have been insufficient data about the flow velocity criteria for significant restenosis after CEA. Although the flow velocity thresholds for restenosis after CAS and CEA seem to be different, the large studies used the same duplex criteria to define restenosis after the two procedures. Moreover, different studies used different flow velocity thresholds to define ICA restenosis, leading to variable restenosis rates.DiscussionWe conclude that (1) further examinations are warranted to determine appropriate duplex US criteria for restenosis after CAS and CEA, (2) single duplex US parameter cannot be used to reliably determine the degree of ICA restenosis, (3) inappropriate US criteria used in large studies may have led to false restenosis rates, and (4) studies are required to determine if there is a benefit from redo carotid artery procedure, such as redo-CEA or redo-CAS, starting with prospective risk stratification studies using current best practice non-invasive care alone.

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Propensity-Matched Comparison for Carotid Artery Stenting in Primary Stenosis Versus after Carotid Endarterectomy Restenosis

Cited by 3 publications

References 31 publications

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Short- and Mid-Term Outcomes of Stenting in Patients with Isolated Distal Internal Carotid Artery Stenosis or Post-Surgical Restenosis

Contemporary Results of Carotid Artery Stenting Using Low-Profile Dual-Metal Layer Nitinol Micromesh Stents in Relation to Single-Layer Carotid Stents

Role of carotid duplex in the assessment of carotid artery restenosis after endarterectomy or stenting

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