Carotid Artery Stenting for Recurrent Carotid Artery Restenosis After Previous Ipsilateral Carotid Artery Endarterectomy or Stenting (original) (raw)
Related papers
2010
Background and Purpose-Carotid artery stenosis causes up to 10% of all ischemic strokes. Carotid endarterectomy (CEA) was introduced as a treatment to prevent stroke in the early 1950s. Carotid stenting (CAS) was introduced as a treatment to prevent stroke in 1994. Methods-The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) is a randomized trial with blinded end point adjudication. Symptomatic and asymptomatic patients were randomized to CAS or CEA. The primary end point was the composite of any stroke, myocardial infarction, or death during the periprocedural period and ipsilateral stroke thereafter, up to 4 years. Results-There was no significant difference in the rates of the primary end point between CAS and CEA (7.2% versus 6.8%; hazard ratio, 1.11; 95% CI, 0.81 to 1.51; Pϭ0.51). Symptomatic status and sex did not modify the treatment effect, but an interaction with age and treatment was detected (Pϭ0.02). Outcomes were slightly better after CAS for patients aged Ͻ70 years and better after CEA for patients aged Ͼ70 years. The periprocedural end point did not differ for CAS and CEA, but there were differences in the components, CAS versus CEA (stroke 4.1% versus 2.3%, Pϭ0.012; and myocardial infarction 1.1% versus 2.3%, Pϭ0.032). Conclusions-In CREST, CAS and CEA had similar short-and longer-term outcomes. During the periprocedural period, there was higher risk of stroke with CAS and higher risk of myocardial infarction with CEA. Clinical Trial Registration-www.clinicaltrials.gov. Unique identifier: NCT00004732. (Stroke. 2010;41[suppl 1]:S31-S34.)
Long -- term results after simultaneous carotid and coronary revascularization
Background and aim: The revascularization strategy for concomitant carotid and coronary disease is still unknown. Simultaneous or stage CAS and CEA are the most common revascularization approach in the CABG population. This study aimed to evaluate long-term results after simultaneous carotid artery stenting (CAS) or carotid endarterectomy (CEA) in the patients who underwent CABG. Methods: This is a prospective cohort non-randomized single-centre study. During the period from April 2012 to February 2015, sixty consecutive patients (65.9±7.41 mean) underwent simultaneous CAS and CABG (n = 30) or simultaneous CEA and CABG (n = 30). The primary endpoints were rates of periprocedural adverse events (transient ischemic attack, stroke, myocardial infarction, and death) and long-term results. The mean follow-up was 62.05±11.12 months. Results: In-hospital mortality was insignificantly higher in CEA and CABG group (6.6% vs 0%), the rate of stroke and myocardial infarction were similar (13.3% and 0% in the CEA and CABG group vs 6.6% and 3.3% in the CAS and CABG group, respectively). The readmission in the ICU was significantly higher in the surgical revascularization approach; it was an independent predictor of hospital mortality. The overall mortality during the follow-up period was 14.28% in both groups. Freedom of the composite adverse outcomes (stroke, myocardial infarction, and death) was 78.55%. Conclusions: Adequate selection for CAS or CEA contributes to similar short-and long-term results, but patients who underwent CEA and CABG had slower recovery and more frequent readmission in the ICU, which was the independent risk factor of in-hospital mortality.
JAMA Surgery, 2014
IMPORTANCE While the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) has been widely accepted as a landmark trial establishing an equivalent risk of major adverse events following carotid endarterectomy (CEA) or carotid artery stenting (CAS), the applicability of these findings to single centers has been questioned owing to the rigid selection criteria for investigators in the study. Although refuted by the findings of a subsequent study, a substudy of CREST established a higher periprocedural stroke rate for CAS when the surgeon was a vascular surgeon. OBJECTIVE To present our 30-day results of stroke, death, myocardial infarction, and composite major adverse events to determine if a single vascular surgeon's outcomes at our hospital are consistent with the results of CREST.
Management of in-sent restenosis after carotid artery stenting in high-risk patients
Journal of Vascular Surgery, 2006
Background: Carotid artery stenting (CAS) has emerged as an acceptable treatment alternative in patients with carotid bifurcation disease. Although early results of CAS have been promising, long-term clinical outcomes remain less certain. We report herein the frequency, management, and clinical outcome of in-stent restenosis (ISR) after CAS at a single academic institution. Methods: Clinical records of 208 CAS procedures in 188 patients with carotid stenosis of 80% or greater, including 48 (26.5%) asymptomatic patients, during a 42-month period were analyzed. Follow-up serial carotid duplex ultrasound scans were performed. Selective angiography and repeat intervention were performed when duplex ultrasound scans showed 80% or greater ISR. Treatment outcomes of ISR interventions were analyzed. Results: Over a median 17-month follow-up, 33 (15.9%) ISRs of 60% or greater were found, according to the Doppler criteria. Among them, seven patients (3.4%) with a mean age of 68 years (range, 65-87 years) developed high-grade ISR (>80%), and they all underwent further endovascular interventions. Six patients with high-grade ISR were asymptomatic, whereas one remaining patient presented with a transient ischemic attack. Five of seven ISRs occurred within 12 months of CAS, and two occurred at 18 months' follow-up. Treatment indications for initial CAS in these seven patients included recurrent stenosis after CEA (n ؍ 4), radiation-induced stenosis (n ؍ 1), and high-cardiac-risk criteria (n ؍ 2). Treatment modalities for ISR included balloon angioplasty alone (n ؍ 1), cutting balloon angioplasty alone (n ؍ 4), cutting balloon angioplasty with stent placement (n ؍ 1), and balloon angioplasty with stent placement (n ؍ 1). Technical success was achieved in all patients, and no periprocedural complications occurred. Two patients with post-CEA restenosis developed restenosis after ISR interventions, both of whom were successfully treated with cutting balloon angioplasty at 6 and 8 months. The remaining five patients showed an absence of recurrent stenosis or symptoms during a mean follow-up of 12 months (range, 3-37 months). By using the Kaplan-Meier analysis, the freedom from 80% or greater ISR after CAS procedures at 12, 24, 36, and 42 months was 97%, 97%, 96%, and 94%, respectively.
Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease
Stroke, 2019
Background and Purpose— We investigated whether procedural stroke or death risk of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) is different in patients with and without history of coronary heart disease (CHD) and whether the treatment-specific impact of age differs. Methods— We combined individual patient data of 4754 patients with symptomatic carotid stenosis from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]). Procedural risk was defined as any stroke or death ≤30 days after treatment. We compared procedural risk between both treatments with Cox regression analysis, stratified by history of CHD and age (<70, 70–74, ≥75 years). History of CHD included myocardial infarction, angina, or coronary re...
Early Outcomes of Carotid Revascularization in Retrospective Case Series
Journal of Clinical Medicine, 2021
Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities. Methods: A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis. Results: In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77–1.25; I2 = 0%), myocardial ischemic events (OR 1.03; 0.72–1.48; I2 = 0%) and all events (OR 1.0; 0.82–1.21; I2 = 0%). Pooled stroke incidence in asymptomatic pat...
The American Journal of Cardiology, 2007
Repeat carotid endarterectomy (CEA) for recurrent stenosis remains a challenging treatment option associated with high morbidity and mortality. Carotid artery stenting (CAS) is an attractive alternative management option for these patients. However, data about the effectiveness and safety of CAS in a large number of unselected patients are less known. We evaluated 3,070 patients who underwent CAS enrolled in a German registry from 1996 to 2006 at 31 sites. We compared clinical and angiographic features and inhospital outcomes of patients with and without previous CEA who underwent CAS. Of 3,070 patients in the registry, 223 (7.3%) underwent CAS for restenosis after previous CEA. Median age was similar in patients with and without previous CEA (70 years, interquartile range 64 to 76 vs 71 years, interquartile range 65 to 76). Ipsilateral neurologic symptoms occurred in approximately 1/2 the patients in both groups. Other co-morbid conditions and angiographic or procedural factors did not differ between the 2 groups. Inhospital events including death (0% vs 0.4%), ipsilateral major stroke (1.4% vs 1.5%), death or major ipsilateral stroke (1.4% vs 1.7%), ipsilateral transient ischemic attack (1.9% vs 2.8%), myocardial infarction (0.4% vs 0.1%), and reintervention (0.7% vs 0.4%) were all low and not significantly different between those with and without previous CEA (p >0.05 for all comparisons). In conclusion, our data for a large number of patients who underwent CAS in a recent contemporary community-based practice attests to the low risk of periprocedural events in patients with recurrent stenosis after previous CEA. This low risk along with the less invasive nature of the procedure should make CAS an attractive and perhaps preferred option for the treatment of these patients.