The long-term outcome of carotid artery stenting or antiplatelet therapy in patients with severe carotid artery stenosis

Sun, Yu-heng; Ma, Zhigui; Zheng, Huaguang; Peng, Xiaoxin; Yan, Xiaofeng

doi:10.1179/174313209x444062

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…In comparison with CEA, CAS is focused for its benefits in the treatment of carotid artery stenosis. [1][2][3] Previous researches suggested that CAS is equally effective and safe in the treatment of carotid artery disease. [4][5][6] Recently, with the accumulation of physician's experience, the improvement in equipment and material, and especially the routine use of cerebral embolic protection devices, CAS surgery now have even better performance than that reported for CEA surgery in many centers.…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors for Medical Complications and 30-Day End points After Carotid Artery Stenting

Wang

Sheng

et al. 2013

Vasc Endovascular Surg

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With the extensive use of carotid artery stenting (CAS) surgeries, scholars are paying more attention to the safety and efficiency of CAS. Our study aims to analyze the clinical efficiency, safety, and technical feasibility of CAS surgery in the treatment of carotid artery stenosis. A total of 379 cases of CAS were collected and retrospectively analyzed. The outcomes were summarized according to decrease in stenosis extent, incidence of early complications after procedure, 30-day end point events, and the follow-up data. Logistic regression was employed to analyze the correlations between risk factors and complications within 30 days and 30-day end points of stroke, myocardial infarctions (MIs), and mortality. The average extent of stenosis reduced from preoperative (81% ± 17%) to postoperative (26% ± 17%). In all, 53 patients had 72 medical complications, including 6 (1.58%) cerebral hemorrhage, 7 (1.85%) cerebral infarction, 5 (1.32%) transient ischemic attack (TIA), 5 (1.32%) heart failure, 10 (2.63%) symptomatic hypertension, 21 (5.54%) symptomatic hypotension, 10 (2.63%) symptomatic bradycardia, and 8 other complications; 15 patients had at least 2 complications. Advanced age, diabetes, and heart failure were associated with the high incidence of early complications (P < .05). Asymptomatic stenosis (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.131-1.131, P = .0426) and diabetes (OR = 3.38, 95% CI: 1.340-8.574, P = .0099) were correlated with the incidence of 30-day end point events. Diabetes and symptomatic stenosis are independent risk factors for 30-day end point events of CAS. Advanced age, hypertension, and vascular unstable plaque will increase the risk of postoperative complications.

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Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors for Medical Complications and 30-Day End points After Carotid Artery Stenting

Wang

Sheng

et al. 2013

Vasc Endovascular Surg

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“…Some researchers have reported that perhaps aspirin use provides a protective effect against ISR. [33][34][35] The most important lesson from this finding for our group is that we should strive to achieve >95% compliance with aspirin therapy in all our carotid patients. Unexpectedly, under univariate analysis, we found that statin use preoperatively or at discharge was associated with an increased risk for ISR.…”

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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Long-Term Prevention of Stroke

Rango

Parlani

Verzini

et al. 2011

Journal of the American College of Cardiology

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The long-term outcome of carotid artery stenting or antiplatelet therapy in patients with severe carotid artery stenosis

Cited by 3 publications

References 10 publications

Incidence and Risk Factors for Medical Complications and 30-Day End points After Carotid Artery Stenting

Incidence and Risk Factors for Medical Complications and 30-Day End points After Carotid Artery Stenting

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

Long-Term Prevention of Stroke

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