Comparison of Carotid Artery Stenting in Patients With Single Versus Bilateral Carotid Artery Disease and Factors Affecting Midterm Outcome

Veselka, Josef; Zimolová, Petra; Špaček, Miroslav; Hájek, Petr; Malý, Martin; Tomašov, Pavol; Martinkovičová, Lucie; Zemánek, David

doi:10.1016/j.avsg.2011.02.011

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Veselka et al found a significantly higher rate of restenosis in the group with bilateral carotid stenosis (vs. unilateral stenosis). This group was also characterized by a higher rate of follow-up death [23]. Another study showed contralateral carotid artery occlusion as a strong independent predictor of in-stent restenosis [24].…”

Section: Discussionmentioning

confidence: 94%

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Tekieli¹,

Musiałek²,

Kabłak‐Ziembicka³

et al. 2019

pwki

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Introduction: Optimal management of severe carotid in-stent restenosis remains unknown. Prevalence and risk factors of first and recurrent carotid in-stent restenosis in the multi-stent approach have not been established yet. Aim: To evaluate the safety of different methods of endovascular treatment of carotid in-stent restenosis/recurrent restenosis and to establish its rate and risk factors. Material and methods: Between January 2001 and June 2016, 2637 neuroprotected carotid artery stenting (CAS) procedures were performed in 2443 patients (men: 67.0%; mean age: 67.9 ±8.8 years, symptomatic: 45.5%). Doppler ultrasound (DUS) evaluation was performed at discharge, after 3-6 months, 12 months, and then annually. Peak systolic velocity of 2-3 and > 3.0 m/s as well as end diastolic velocity of 0.5-0.9 and > 0.9 m/s were DUS criteria for 50-69% and ≥ 70% carotid in-stent restenosis (ISR) respectively. For angiographically confirmed ≥ 70% stenosis balloon re-angioplasty was first line treatment. Results: Out of 95 DUS detected > 50% ISR (95/2637; 3.6%), 53 were confirmed in angiography as ≥ 70% (53/2637; 2.0%, one total occlusion). All patients were treated with bare balloon (n = 19), drug-eluting balloon (n = 27) or stent-supported (n = 6) angioplasty. One procedure was complicated with stroke (1.9%). Angiographic diameter stenosis (DS) was reduced from 83 ±8.3% to 13 ±7.6% (p < 0.001). There were 13 cases of ≥ 70% recurrent ISR. Bilateral and high-grade stenosis were independent risk factors of restenosis. Initial Carotid Wallstent implantation was a risk factor of first and recurrent in-stent restenosis. Conclusions: Endovascular treatment of carotid in-stent restenosis is safe. Bilateral and high-grade carotid artery stenosis may increase the risk of restenosis. Initial Carotid Wallstent implantation may increase the risk of first and recurrent restenosis.

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Section: Discussionmentioning

confidence: 94%

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Tekieli¹,

Musiałek²,

Kabłak‐Ziembicka³

et al. 2019

pwki

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“…Therefore, patients with carotid atherosclerosis are likely to experience not only stroke, but also myocardial infarction and cardiovascular-related death [ 1 ]. It seems to be logical that while a history of recent stroke, clinical presentation, carotid lesion-related factors, and aortic arch/carotid anatomy [ 10 ] are associated with the occurrence of peri-procedural complications and short-term outcomes of CAS patients, any pre-existing comorbidities, including the extent of coronary atherosclerosis, determine long-term survival [ 11 – 14 ]. However, based on a presumption that patients with CAD also have a greater extent of peripheral atherosclerosis, Chung et al .…”

Section: Discussionmentioning

confidence: 99%

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

Veselka¹,

Špaček²,

Horváth³

et al. 2016

aoms

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IntroductionSystemic atherosclerosis can result in both coronary artery disease (CAD) and carotid artery disease. Recently it has been shown that patients with CAD have a higher incidence of microembolization during carotid artery stenting (CAS), and it has been hypothesized that they could be at higher risk in this intervention.Material and methodsWe retrospectively evaluated an institutional registry with 437 consecutive patients who underwent coronary angiography and CAS to evaluate their short-term outcomes and long-term survival with regard to the presence of coexisting multivessel coronary artery disease (MVD).ResultsWe performed 220 CAS procedures in MVD patients and 318 CAS procedures in non-MVD patients. The incidence of in-hospital CAS-related adverse events was 2.7% and 2.5% in the MVD and non-MVD groups, respectively (p = 0.88). At 30 days, there was no significant difference between the groups in terms of the number of patients with adverse events (hierarchically death/stroke/myocardial infarction; 8.8% vs. 5.5%; p = 0.18). The median duration of follow-up was 4.23 years. Survival free of all-cause mortality at 1, 3 and 5 years was 90% (95% CI: 86–94%), 79% (95% CI: 73–85%) and 70% (95% CI: 64–77%), and 92% (95% CI: 89–95%), 85% (95% CI: 80–90%) and 76% (95% CI: 70–82%) for the MVD and non-MVD groups (p = 0.02), respectively.ConclusionsThese results suggest that patients with MVD combined with carotid artery disease are probably not at higher risk of early post-CAS adverse clinical events, but they have significantly worse long-term survival rates.

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“…We retrospectively evaluated data that had been collected prospectively from a single-centre institutional registry of 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures between 2005 and 2019 and were enrolled in this study. Some of the patients were included in previous reports [2][3][4][5].…”

Section: Methodsmentioning

confidence: 99%

“…All CAS procedures were performed by experienced interventional cardiologists after a detailed multidisciplinary evaluation as well as a discussion with the patient and/or his/her family and according to the current guidelines [7][8][9]. The procedural technique details were published previously [2,3].…”

Section: Patient Assessment Procedure and Follow-upmentioning

confidence: 99%

“…Based on one-year data published in the past [2], we hypothesised that patients with double-vessel carotid artery disease (carotid artery disease with symptomatic internal/common carotid artery stenosis ≥ 50% or asymptomatic stenosis ≥ 70%, and contralateral stenosis of the internal or common carotid artery ≥ 50%) have worse long-term survival than patients with single-vessel carotid disease (unilateral carotid artery disease ≥ 50% for symptomatic or ≥ 70% for asymptomatic patients).…”

Section: Introductionmentioning

confidence: 99%

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Long-term survival of carotid stenting patients with regard to single- or double-vessel carotid artery disease: a propensity score matching analysis

et al. 2021

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Introduction: There is lack of long-term data outside of controlled clinical trials in carotid artery stenting (CAS). In this study, we compared the shortterm outcome, long-term survival, and rate of re-interventions for restenosis in patients after CAS, related to the extent of carotid atherosclerosis classified as single-vessel (unilateral) or double-vessel (bilateral) carotid artery disease. Material and methods: We retrospectively evaluated 599 patients with significant carotid artery stenosis, who underwent 763 CAS procedures, and used the propensity score to match 226 pairs (452 patients) in the single-or double-vessel carotid disease. Results: There was no significant difference in the occurrence of in-hospital major adverse events (3.5% vs. 3.1% of patients in the double-vessel carotid group vs. the single-vessel carotid group; p = 1) The mean follow-up was 6.1 ±4.0 years, and a total of 181 (40%) deaths occurred during 2759 patient-years, which translates into 7.8 and 5.3 deaths per 100 patient-years in the double-vessel carotid group and the single-vessel carotid group, respectively (p < 0.01). The survival in the double-vessel carotid group vs. the single-vessel carotid group at 10 years was 46% (95% CI: 38-54%) vs. 55% (95% CI: 47-63%) (p < 0.01). Twenty-four (11%) patients and 6 (3%) patients underwent re-interventions for restenosis in the double-vessel and the single-vessel carotid disease group, respectively (p < 0.01). Conclusions: Patients with CAS and significant double-vessel carotid artery disease had similar peri-procedural risk, but had a worse long-term survival, and a higher rate of re-interventions for restenosis compared to the single-vessel carotid artery disease patients.

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Comparison of Carotid Artery Stenting in Patients With Single Versus Bilateral Carotid Artery Disease and Factors Affecting Midterm Outcome

Cited by 9 publications

References 35 publications

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Impact of coexisting multivessel coronary artery disease on short-term outcomes and long-term survival of patients treated with carotid stenting

Long-term survival of carotid stenting patients with regard to single- or double-vessel carotid artery disease: a propensity score matching analysis

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