Stenting versus endarterectomy after prior ipsilateral carotid endarterectomy

Arhuidese, Isibor; Obeid, Tammam; Nejim, Besma; Locham, Satinderjit; Hicks, Caitlin W.

doi:10.1016/j.jvs.2016.07.115

Cited by 36 publications

(27 citation statements)

References 36 publications

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“…4,12 A possible explanation for this finding is that the present study used a very accurate otolaryngological surveillance program, while in the majority of the published studies, the diagnosis of cranial nerve injuries was surgeon driven; this could have contributed to the diagnosis of minimal peripheral lesions in the current study, which might be under reported in other series. 5 Furthermore, in the present study the majority of cranial nerve injuries were reversible, and when the rate of permanent lesions only was analysed, the percentage of cranial nerve injuries fell to 3%, which is in line with the data in the literature.…”

Section: Discussionsupporting

confidence: 92%

“…Most importantly, the duration of follow-up was similar between the two groups, while previous studies have observed a significantly shorter follow-up time in CAS patients. 5 Followup results were fairly good, with satisfactory survival rates and a very limited number of neurological events at 5 years. In their meta-analysis, Fokkema et al 3 reported only seven strokes and seven deaths during follow-up among 453 patients treated by CAS and 731 patients treated by redo CEA, after a mean follow-up of 13 months.…”

Section: Discussionmentioning

confidence: 88%

“…After propensity matching, it was possible to compare early and late outcomes of CAS and redo CEA in clinically and anatomically equivalent populations. Recently, Arhuidese et al 5 performed a similar analysis in a very large cohort of 1862 patients; however, in that study the time between primary and secondary intervention was not reported and the authors were unable to stratify the results for that parameter.…”

Section: Discussionmentioning

confidence: 99%

“…2 On the other hand, several studies and metaanalyses have shown similar rates of peri-operative complications with these techniques, 3,4 while the risk of neurological complications and development of secondary restenosis during follow-up varies widely among the published data. 5,6 One possible explanation for these inconsistent results is that most published studies include heterogeneous patients in terms of demographic, clinical, and anatomical characteristics. Moreover, the duration of follow-up often varies between CAS and redo CEA.…”

Section: Introductionmentioning

confidence: 99%

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A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

Dorigo

Fargion

Giacomelli

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

Dorigo

Fargion

Giacomelli

et al. 2018

European Journal of Vascular and Endovascular Surgery

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“…Numerous studies investigated association between carotid plaques progression and the risk of cerebrovascular events in patients with asymptomatic carotid stenosis [29,30]. Most of the previous studies used standard flow velocity [31].…”

Section: Discussionmentioning

confidence: 99%

Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study

et al. 2018

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Background and objectives: Brain ischemic stroke is caused by impaired or absolutely blocked blood flow into the brain regions. Despite the large number of possible origins, there is no general strategy for preventive treatment. In this paper, we aimed to predict the hemodynamics in a patient who experienced a critical stenosis operation in the carotid artery. This is a unique study where we used medical data together with the computational fluid (CFD) technique not to plan the surgery, but to predict its outcome. Materials and Methods: AngioCT data and blood perfusion of brain tissue (CT-perfusion) together with CFD technique were applied for stroke formation reconstruction in different clinical conditions. With the use of self-made semiautomatic algorithm for image processing and 3DDoctror software, 3D-vascular geometries before and after surgical intervention were reconstructed. As the paper is focused on the analysis of stroke appearance, apparent stroke was simulated as higher and lower pressure values in the cranial part due to different outcomes of the surgical intervention. This allowed to investigate the influence of spatial configuration and pressure values on blood perfusion in the analyzed circulatory system. Results: Application of CFD simulations for blood flow reconstruction for clinical conditions in the circulatory system accomplished on average 98.5% and 98.7% accuracy for CFD results compared to US-Doppler before and after surgical intervention, respectively. Meanwhile, CFD results compared to CT-perfusion indicated an average 89.7% and 92.8% accuracy before and after surgical intervention, respectively. Thus, the CFD is a reliable approach for predicting the patient hemodynamics, as it was confirmed by postoperative data. Conclusions: Our study indicated that the application of CFD simulations for blood flow reconstruction for clinical conditions in circulatory system reached 98% and 90% accuracy for US-Doppler and CT-perfusion, respectively. Therefore, the proposed method might be used as a tool for reconstruction of specific patients’ hemodynamics after operation of critical stenosis in the carotid artery. However, further studies are necessary to confirm its usefulness in clinical practice.

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Risks Associated With Primary and Redo Carotid Endarterectomy in the Endovascular Era

et al. 2018

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IMPORTANCE Clinical experience suggests worse outcomes for redo carotid endarterectomy (CEA) relative to primary CEA. Objective quantification of the excess risk attributable to redo CEA in this era of proliferating endovascular therapy remains to be determined. OBJECTIVE To evaluate the risks of redo CEA relative to primary CEA. DESIGN, SETTING, AND PARTICIPANTSThis study was a retrospective analysis of a prospective cohort of patients maintained by the Society for Vascular Surgery in the Vascular Quality Initiative between January 1, 2003, and April 30, 2016. The setting was consecutive patients from academic and community hospitals across the United States. Participants were patients who underwent primary CEA or redo CEA for symptomatic or asymptomatic carotid stenosis.EXPOSURES Primary CEA and redo CEA.MAIN OUTCOMES AND MEASURES Stroke, death, myocardial infarction, stroke or death, and stroke, death, or myocardial infarction at 30 days and 1 year. RESULTS There were 64 118 CEAs recorded, including 62 749 primary CEAs (97.9%) (median age, 71 years; 39.5% female) and 1369 redo CEAs (2.1%) (median age, 71 years; 42.2% female). Comparing primary CEA vs redo CEA, the incidence of 30-day stroke was 0.7% vs 1.9% (P < .001) for asymptomatic patients and 1.5% vs 1.4% (P = .77) for symptomatic patients for an overall 0.9% vs 1.8% (P = .002). Incidences were 0.8% vs 1.3% (P = .09) for perioperative myocardial infarction, 0.6% vs 1.4% (P = .003) for death, and 1.5% vs 2.6% (P = .001) for stroke or death. Risk-adjusted 30-day stroke (odds ratio [OR], 2.82; 95% CI, 1.69-4.71; P < .001), death (OR, 2.15; 95% CI, 1.21-3.79; P = .009), and stroke or death (OR, 2.06; 95% CI, 1.32-3.23; P = .002) were higher for redo CEA compared with primary CEA among asymptomatic patients but were similar among symptomatic patients for stroke (OR, 0.79; 95% CI, 0.33-1.95; P = .62), death (OR, 1.32; 95% CI, 0.53-3.26; P = .55), and stroke or death (OR, 0.85; 95% CI, 0.39-1.82; P = .68). Stroke or death at 1 year among asymptomatic patients was higher for redo CEA (hazard ratio [HR], 1.36; 95% CI, 1.08-1.69; P = .009) but was similar among symptomatic patients (HR, 0.94; 95% CI, 0.67-1.31; P = .71). CONCLUSIONS AND RELEVANCEThe outcomes of redo CEA and primary CEA fall within the professional guidelines for carotid revascularization. However, redo CEA is associated with a 2.8 times increase in the risk of stroke and a 2.2 times increase in the risk of death compared with primary CEA among asymptomatic patients. There is no significant difference in outcomes among symptomatic patients. These redo CEA and primary CEA results should inform patient and clinician expectations at the point of care.

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Stenting versus endarterectomy after prior ipsilateral carotid endarterectomy

Cited by 36 publications

References 36 publications

A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

A Propensity Matched Comparison for Open and Endovascular Treatment of Post-carotid Endarterectomy Restenosis

Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study

Risks Associated With Primary and Redo Carotid Endarterectomy in the Endovascular Era

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