Stenting Versus Endarterectomy for Restenosis Following Prior Ipsilateral Carotid Endarterectomy

Fokkema, Margriet; Vrijenhoek, Joyce E. P.; Ruijter, Hester M. den; Groenwold, Rolf H H; Schermerhorn, Marc L.; Bots, Michiel L.; Pasterkamp, Gérard; Moll, Frans L.; Borst, Gert J. de

doi:10.1097/sla.0000000000000799

Cited by 54 publications

(19 citation statements)

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“…Based on the results of a Kaplan-Meier analyses, the incidence of in-stent restenosis was 10.87% (95% CI 4.56–16.77) after two years. These results show that in-stent restenosis may not limit the benefits of CAS for recurrent lesions as much as was previously thought; The rate of in-stent restenosis is similar to the rate of restenosis after redo surgery [ 8 , 9 , 26 , 27 ]…”

Section: Discussionsupporting

confidence: 56%

“…In literature, the incidence of cranial nerve injuries has been reported to range from 1% to 17%, and studies show that most such reported injuries are transient. [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have compared CAS to redo surgery [ 5 – 7 , 10 – 12 ]. The short-term results of these studies have revealed that there is no significant difference between the two treatments [ 5 – 7 , 9 – 13 ]. Endovascular treatment provides an advantage in that it reduces the risk of cranial nerve injury [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis

et al. 2016

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BackgroundCarotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis.MethodsWe performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death).ResultsA total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6–171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis.ConclusionWe identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.

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Section: Discussionsupporting

confidence: 56%

“…In literature, the incidence of cranial nerve injuries has been reported to range from 1% to 17%, and studies show that most such reported injuries are transient. [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis

et al. 2016

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“…17 In our review, we did not find gender or dyslipidemia to be independent predictors, but only PVD, which was also an independent predictor of TVR along with age <65 years. An important recent meta-analysis 38 reported short-term outcomes of 13 studies that included 1132 patients who were treated with CAS or CEA for carotid restenosis after previous CEA. Symptomatic lesions were treated with CAS (30%) or with CEA (40%).…”

Section: Discussionmentioning

confidence: 99%

Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions

et al. 2015

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Purpose: To report the long-term outcomes of patients who underwent carotid artery stenting (CAS) for de novo carotid stenosis vs patients treated for restenosis after carotid endarterectomy (CEA). Methods: A retrospective review was conducted of all 385 patients (mean age 68.6±9.6 years; 231 men) who underwent 435 CAS procedures at a large tertiary care center between January 1999 and December 2013. For analysis, patients were stratified based on their lesion type [de novo (dn) vs post-CEA restenosis (res)] and subclassified by symptoms status [symptomatic (Sx) or asymptomatic (Asx)], creating 4 groups: (1) CAS-dn Asx, (2) CAS-dn Sx, (3) CAS-res Asx, and (4) CAS-res Sx. For the CAS-res group, the mean elapsed time from CEA to CAS was 72.4±63.6 months. Outcomes included target vessel reintervention (TVR) and in-stent restenosis (ISR), the latter defined by a carotid duplex ultrasound velocity >275 cm/s. Results: The main indication for initial carotid angiography with possible revascularization was severe carotid stenosis (≥70%-99% on duplex) in both CAS-dn and CAS-res groups (83.6% vs 83.7%, p=0.999). There were no significant differences in the percentage of patients with postintervention residual stenosis (<30%; 100% each arm) or complications between CAS-res vs CAS-dn: in-hospital stroke (1.4% vs 1.8%, respectively), myocardial infarction (0.9% vs 0%), or death (0.9% vs 0%). Mean follow-up was 62.4±45.6 months (median 53.5, range 1–180). Average clinical/TVR follow-up was greater for the CAS-res group (71.9±48.6 months) compared with 53.3±40.5 months for the CAS-dn group (p<0.001). Across the 4 study groups, there were no differences in freedom from ISR (p=0.174) or TVR (p=0.856). Multivariate analysis found peripheral vascular disease (PVD) as the sole ISR independent predictor [hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.03 to 3.62, p=0.041], while significant predictors for TVR were age <65 years at the time of the procedure (HR 2.55, 95% CI 1.05 to 6.18, p=0.039) and PVD (HR 2.46, 95% CI 1.03 to 5.87, p=0.043). Conclusion: The current study suggests that CAS is a feasible and durable therapeutic option for recurrent restenosis after CEA. Long-term outcomes were similar for patients treated for de novo lesions or post-CEA restenosis. Age and PVD appear to influence long-term CAS durability.

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“…Carotid restenosis is not uncommon, and the incidence of symptomatic restenosis, usually occurring within 2 years after CEA, has been reported to range between 0.6% and 3.6% [6,8]. In a recent meta-analysis, Fokkema et al [21] observed that two-thirds of reinterventions for restenoses were undertaken for patients with asymptomatic lesions, suggesting that many surgeons and interventional radiologists were reluctant not to reintervene. However, considering that most restenoses are generally benign and do not require reintervention [4], controversy exists regarding whether the occurrence of restenosis after CEA is https://doi.org/10.1371/journal.pone.0244544.g001…”

Section: Plos Onementioning

confidence: 99%

Duplex ultrasound findings and clinical outcomes of carotid restenosis after carotid endarterectomy

et al. 2020

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This study aimed to describe the duplex ultrasound (DUS) findings associated with carotid restenosis after carotid endarterectomy (CEA) and to determine whether carotid restenosis is associated with the clinical outcomes of CEA. Between January 2007 and December 2016, a total of 660 consecutive patients who underwent 717 CEAs were followed up at our hospital with DUS surveillance for at least 3 years after CEA. These patients were analyzed retrospectively for this study. Following CEA, restenosis was defined as the development of ≥50% stenosis, diagnosed on the basis of DUS findings of the luminal narrowing and velocity criteria. The study outcomes were defined as restenosis of the ipsilateral carotid artery after CEA and late (>30days) fatal or nonfatal stroke ipsilateral to the carotid restenosis. During the median follow-up period of 74 months, the restenosis incidence was 2.8% (20/717), and there were 2 strokes (2/20, 10%) ipsilateral to the restenosis after CEA; reintervention was performed for 11 patients with carotid restenosis (55%). Within 2 years after CEA, restenosis was identified in 9 cases (45%, 9/20), and 8 reinterventions (72.7%, 8/11) were performed. According to DUS findings, the morphologic characteristics of carotid restenosis were different from the preoperative plaque morphology. Among the 20 carotid restenosis cases, we observed the following DUS patterns: homogenous isoechoic restenosis (n = 14, 70%), homogenous hypoechoic (n = 2, 10%), isoechoic with hypoechoic surface (n = 3, 15%), and hypoechoic with isoechoic surface (n = 1, 5%). Although 9 carotid restenosis patients received prophylactic reintervention to mitigate the progression of restenosis, the 2 symptomatic restenosis patients had isoechoic lesions with hypoechoic surfaces on DUS. On Kaplan–Meier survival analyses, in terms of stroke-free survival rates, there was a higher risk of stroke among patients with carotid restenosis compared with patients without restenosis, with a non-significant trend (P = 0.051). In conclusion, most carotid restenoses were identified within 2 years after CEA, and there was a non-significant trend toward a higher risk of stroke among patients with carotid restenosis.

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Stenting Versus Endarterectomy for Restenosis Following Prior Ipsilateral Carotid Endarterectomy

Abstract: In patients with restenosis after CEA, CAS and CEA showed similar low rates of stroke, death, and restenosis at short-term follow-up. Still, the risk of CNI and other procedure-related complications should be taken into account.

Cited by 54 publications

References 55 publications

Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis

Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis

Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions

Duplex ultrasound findings and clinical outcomes of carotid restenosis after carotid endarterectomy

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