Differential Effects of Carotid Artery Stenting versus Carotid Endarterectomy on External Carotid Artery Patency

Woo, Edward Y.; Karmacharya, Jagajan; Velázquez, Omaida C.; Carpenter, Jeffrey P.; Skelly, Christopher L.; Fairman, Ronald M.

doi:10.1177/152660280701400213

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…Whereas previous studies have shown an increased rate of ECA stenosis with CAS, 17–19 this is the first study to find an increased rate of ECA occlusion. ECA exclusion as a result of CAS has recently been demonstrated to alter the arterial flow patterns into the ECA, in part owing to poor apposition of the stent to the ECA orifice.…”

Section: Discussionmentioning

confidence: 49%

“…Unfortunately, this report did not address whether the patients with occluded ECAs had irradiation. 19 Whereas the preoperative ECA peak systolic velocities were similar between CAS patients regardless of whether ECA occlusion occurred, the end-diastolic velocity increased in those who went on to occlude. Here the absolute difference was small (44 cm/s vs 31 cm/s), and we are not sure what role a small increase in end-diastolic velocity in the ECA had on our findings.…”

Section: Discussionmentioning

confidence: 86%

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Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Brown

Itum

Preiss

et al. 2015

Journal of Vascular Surgery

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Objective The external carotid artery (ECA) can be an important source of cerebral blood flow in cases of high-grade internal carotid artery stenosis or occlusion. However, the treatment of the ECA is fundamentally different between carotid endarterectomy (CEA) and carotid artery stenting (CAS). CEA is routinely associated with endarterectomy of the ECA, whereas CAS excludes the ECA from direct flow. We hypothesize that these differences make ECA occlusion more common after CAS. Further, the impact of CAS on blood flow into the ECA is interesting because the flow from the stent into the ECA is altered in a way that may promote local inflammation and may influence instent restenosis (ISR). Thus, our objective was to use our institutional database to identify whether CAS increased the rate of ECA occlusion and, if it did, whether ECA occlusion was associated with ISR. Methods Patients undergoing CAS or CEA from February 2007 to February 2012 were identified from our institutional carotid therapy database. Preoperative and postoperative images of patients who followed up in our institution were included in the analysis of ECA occlusion and rates of ISR. Results There were 210 (67%) CAS patients and 207 (60%) CEA patients included in this analysis. Despite CAS patients being younger (68 vs 70 years), having shorter follow-up (12.5 vs 56.2 months), and being more likely to take clopidogrel (97% vs 35%), they had an increased rate of ECA occlusion (3.8%) compared with CEA patients (0.4%). CAS patients who went on to ECA occlusion had an increased incidence of prior neck irradiation (50% vs 15%; P = .03), but we did not identify an association of ECA occlusion with ISR >50%. Conclusions Whereas prior publications have identified increased rates of external carotid stenosis, this is the first demonstration of increased ECA occlusion after CAS. However, ECA occlusion is uncommon (~4%) and did not have an association with ISR >50%. Future work modeling ECA flow patterns before and after CAS will be used to further test this interaction.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 86%

Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Brown

Itum

Preiss

et al. 2015

Journal of Vascular Surgery

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“…10 Concern about the effects of ECA coverage should not deter stent extension from the ICA to the CCA during CAS. 19 In another study, only two new ECA occlusions occurred after CAS and neither of the ECA occlusions had neurological sequelae. The findings from this retrospective analysis are in line with our prospective, randomized observations.…”

Section: Discussionmentioning

confidence: 92%

Flow Velocities in the External Carotid Artery Following Carotid Revascularization

Reichmann

Hellings

Worp

et al. 2013

European Journal of Vascular and Endovascular Surgery

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“…6e8 In other studies, patients who underwent carotid stenting were observed to have a significantly greater mean increase in peak systolic velocities (PSVs) of the ECA and higher rate of occlusion when compared with patients who underwent open carotid procedures. 7,9,10 Interestingly, however, this group of patients did not have evidence of progression to full occlusion at 2-year follow-up. 10 These patients in general remain asymptomatic with regard to their cerebral circulation, although jaw claudication has been associated with ECA stenosis after stenting.…”

Section: Introductionmentioning

confidence: 64%

External Carotid Artery Stenosis after Internal and Common Carotid Stenting

Siracuse

Epelboym

et al. 2015

Annals of Vascular Surgery

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Differential Effects of Carotid Artery Stenting versus Carotid Endarterectomy on External Carotid Artery Patency

Cited by 7 publications

References 22 publications

Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Carotid artery stenting has increased risk of external carotid artery occlusion compared with carotid endarterectomy

Flow Velocities in the External Carotid Artery Following Carotid Revascularization

External Carotid Artery Stenosis after Internal and Common Carotid Stenting

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