Carotid Artery Angioplasty for Restenosis Following Endarterectomy

McDonnell, Ciarán; Legge, David; Twomey, Eilish; Kavanagh, Eoin; Dundon, S; O’Donohoe, Martin K.; O'Malley, Michael K.; Corrigan, T.

doi:10.1016/j.ejvs.2003.09.011

Cited by 18 publications

(14 citation statements)

References 18 publications

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“…In our opinion, CAS in experienced hands should be considered the primary treatment option for restenosis after prior CEA. Earlier series of CAS after CEA [13][14][15][16]26 have also shown a low periprocedural event rate comparable with our results. Only three previous studies [27][28][29] have specifically compared CAS for restenosis after CEA with CAS for primary stenosis.…”

Section: Discussionsupporting

confidence: 93%

“…11 Because CAS is not hampered by previous neck dissection, it has been considered as an alternative to redo surgery in these patients, and encouraging results have been published within the last decade. [12][13][14][15][16] The main culprit in early restenosis after CEA is hypothesized to be myointimal hyperplasia (MIH), whereas late restenosis is generally considered to result from progression of the underlying atherosclerotic disease. 17 Because MIH is supposed to be more stable and less embologenic, 18 the procedural risk of emboli might be lower in CAS after prior ipsilateral CEA compared with primary CAS, especially in early restenoses.…”

mentioning

confidence: 99%

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Carotid angioplasty and stenting: Treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment

Vos

Borst

Overtoom

et al. 2009

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Carotid angioplasty and stenting: Treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment

Vos

Borst

Overtoom

et al. 2009

Journal of Vascular Surgery

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“…Regarding the rate of immediate neurologic and/or fatal complications, our results seem to be similar to those reported in previous series (Table V) 12,13, but also to those published with CAS (Table VI). 10,11,[49][50][51][52][53][54][55][56][57] Indeed, apart from two series of OS with a CMSM of 10.5, and 9.7%, respectively, all reported rates of CMSM were between 0% and 6.3% regardless of the technique used (Tables V and VI).…”

Section: Discussionmentioning

confidence: 95%

Open surgery remains a valid option for the treatment of recurrent carotid stenosis

Coscas

Gruet-Coquet

Couture

et al. 2010

Journal of Vascular Surgery

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OS for RCS is not a high-risk procedure and provides excellent long-term results, with low rates of tertiary RCS and reinterventions. The comparison between OS and CAS in this indication suffers from the absence of standardized follow-up paradigms after primary OS and the lack of prospective randomized trial comparing the two techniques. Despite these limitations in the available data, we conclude that OS should remain the first line therapy when treatment of RCS is indicated.

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“…Carotid endarterectomy (CEA) can reduce the risk of stroke in patients with symptomatic Յ70% stenosis of the cervical ICA 1 . However, recurrent stenosis is being found in a substantial number of patients (up to 37%) during the three-year period after CEA [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

Restenosis after Carotid Endarterectomy: Incidence and Endovascular Management

et al. 2007

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Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems. We aimed to evaluate the incidence of carotid artery restenosis following CEA, and to evaluate the safety and efficacy of treating post-CEA restenosis with an endovascular technique (PTAS). One hundred and two patients who underwent CEA for symptomatic and asymptomatic stenosis were included in the analysis. Clinical and sonographic follow-up examinations identified carotid artery restenosis in 16 patients, who fulfilled our criteria for endovascular treatment. Carotid PTAS was performed on symptomatic patients with a stenosis over 60% of the artery lumen (n=7) and in asymptomatic patients with a stenosis over 80% (n=9). The post-PTAS patients were evaluated by duplex sonography every three months over a 24 month follow-up period for evidence of restenosis. The cumulative incidence of post-CEA carotid restenosis qualifying for PTAS was 9.3% during an average 12-month follow-up interval. The average time from CEA to carotid PTAS was 11 months. All 16 endovascular procedures were technically successful. All of the carotid arteries were widely patent following PTAS. There were no immediate perioperative complications. One patient died two days after carotid PTAS from a cerebral hemorrhage. Thirteen of the 16 patients remained asymptomatic and had no sonographic evidence of significant restenosis during the 24-month post-PTAS follow-up period. One patient developed a symptomatic 80% restenosis proximal to the stent six months after carotid PTAS. Another patient developed an asymptomatic 60% restenosis proximal to the stent at 24 months. One patient was lost to follow-up. Following CEA, there is a significant risk of developing a symptomatic or high-grade carotid artery restenosis requiring correction. Endovascular treatment (PTAS) of a recurrent stenosis after CEA is a safe and effective alternative to repeat carotid surgery.

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Carotid Artery Angioplasty for Restenosis Following Endarterectomy

Abstract: Angioplasty is an acceptable alternative to surgery in the management of internal carotid artery restenosis following endarterectomy.

Cited by 18 publications

References 18 publications

Carotid angioplasty and stenting: Treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment

Carotid angioplasty and stenting: Treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment

Open surgery remains a valid option for the treatment of recurrent carotid stenosis

Restenosis after Carotid Endarterectomy: Incidence and Endovascular Management

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