Predictors of Restenosis After Carotid Endarterectomy

Chan, Rcl; Chan, YH; Cheung, Gordon C. K.; Cheng, Swk

doi:10.1177/1538574413518117

Cited by 18 publications

(7 citation statements)

References 33 publications

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“…Lastly, the surgical patch angioplasty method may limit restenosis after drug delivery is reduced below therapeutic levels, e.g. after the drug is exhausted, since the patched site has less tendency for form restenosis, thereby increasing the translational potential of patch angioplasty30313233.…”

Section: Discussionmentioning

confidence: 99%

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Bai

Lee

Chen

et al. 2017

Sci Rep

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Prosthetic grafts and patches are commonly used in cardiovascular surgery, however neointimal hyperplasia remains a significant concern, especially under low flow conditions. We hypothesized that delivery of rapamycin from nanoparticles (NP) covalently attached to patches allows sustained site-specific delivery of therapeutic agents targeted to inhibit localized neointimal hyperplasia. NP were covalently linked to pericardial patches using EDC/NHS chemistry and could deliver at least 360 ng rapamycin per patch without detectable rapamycin in serum; nanoparticles were detectable in the liver, kidney and spleen but no other sites within 24 hours. In a rat venous patch angioplasty model, control patches developed robust neointimal hyperplasia on the patch luminal surface characterized by Eph-B4-positive endothelium and underlying SMC and infiltrating cells such as macrophages and leukocytes. Patches delivering rapamycin developed less neointimal hyperplasia, less smooth muscle cell proliferation, and had fewer infiltrating cells but retained endothelialization. NP covalently linked to pericardial patches are a novel composite delivery system that allows sustained site-specific delivery of therapeutics; NP delivering rapamycin inhibit patch neointimal hyperplasia. NP linked to patches may represent a next generation of tissue engineered cardiovascular implants.

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Section: Discussionmentioning

confidence: 99%

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Bai

Lee

Chen

et al. 2017

Sci Rep

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“…Lipid-lowering therapy has been shown to confer short-and long-term benefit after cardiovascular and cerebrovascular procedures for atherosclerotic disease. [31][32][33][34][35] Patients in the blacks group also had a higher incidence of stroke post CEA. Whether the higher incidence of stroke in black patients is related to a lower prescription of aspirin and statins or not, cannot be analyzed by our study.…”

Section: -Day Outcomesmentioning

confidence: 97%

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

Wayangankar

Kennedy

Aronow

et al. 2015

Stroke

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Background and Purpose— It is not known whether racial or ethnic disparities observed with other revascularization procedures are also seen with carotid artery stenting (CAS) and endarterectomy (CEA). Methods— We compared the utilization and outcomes of CAS and CEA across racial/ethnic groups within the CARE Registry between May 2007 and December 2012. Results— Between 2007 and 2012, of the 13 129 patients who underwent CAS, majority were non-Hispanic whites (89.3%), followed by blacks (4.4%), Hispanics (4.3%), and other groups (2.0%). A similar distribution was observed among the 10 953 patients undergoing CEA (non-Hispanic whites, 92.6%; blacks, 3.5%; Hispanics, 2.8%; and other groups, 1.1%). During this time period, a trend toward proportionate increase in CAS utilization was observed in non-Hispanic whites and other groups, whereas the opposite was observed among Hispanics and blacks. This trend persisted even when hospitals performing both CAS and CEA were exclusively analyzed. Adherence to antiplatelet and statin therapy was significantly lower among blacks post CEA. In-hospital major adverse cardiac and cerebrovascular events remained comparable across groups post CAS and CEA. At 30 days, the incidence of stroke (7.2%) and major adverse cardiac and cerebrovascular events (8.8%) was higher among blacks post CEA ( P <0.05), after risk adjustment. Conclusion— During the study period, utilization of CAS and CEA was highest among non-Hispanic whites. There was a trend toward increased CAS utilization over time among non-Hispanic whites and other groups, and a trend toward increased CEA utilization among Hispanics and blacks. In-hospital major adverse cardiac and cerebrovascular events remained comparable between groups, whereas 30-day major adverse cardiac and cerebrovascular events were significantly higher in blacks.

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“…The North American Symptomatic Carotid Endarterectomy (NASCET) Trial and The Asymptomatic Carotid Atherosclerosis Study provide Class 1 evidence of superior outcomes with endarterectomy as compared to the medical therapy for the prevention of stroke. 1–4) The rate of restenosis after carotid endarterectomy (CEA) was 5–15% as reported previously 5–7) and less frequent with CEA than CAS. 8) Some studies emphasized that patch graft closure and eversion CEA are superior to conventional primary closure CEA at the point of restenosis, although this is yet controversial.…”

Section: Introductionmentioning

confidence: 59%

“…9–12) Moreover, only a few studies reported the long-term outcome, while a majority reported the outcome after CEA with a follow-up period 30 days to 5 years. 4,5,13,14) In Japan, primary closure after endarterectomy has been recognized as a standard closure technique; however, patch angioplasty with hemashield patch has been performed in Tokushima university since 2000.…”

Section: Introductionmentioning

confidence: 99%

A Single-center Retrospective Study with 5- and 10-year Follow-up of Carotid Endarterectomy with Patch Graft

Okazaki

Kanematsu

Shimada

et al. 2019

Neurol. Med. Chir.(Tokyo)

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Carotid endarterectomy (CEA) is widely used for cervical artery stenosis. In Japan, primary closure after endarterectomy has been a standard technique. Recently, the patch closure has been shown to be superior to the primary suture for the prevention of restenosis and ipsilateral stroke. This study evaluated the 5- and 10-year outcomes following CEA with patch graft closure in our institution. Between January 2000 and March 2013, 134 patients, who underwent CEA with patch graft closure were investigated in the current retrospective study. Among these patients, 102 CEAs in 97 patients were followed up for 5 years and 66 CEAs in 61 patients were for 10 years after the procedure. Restenosis was defined as >50% recurrent luminal narrowing at the endarterectomy site. In 5 years, symptomatic restenosis exhibited minor stroke in one patient at 58 months after CEA (restenosis rate 1.0%). The ipsilateral minor stroke occurred in three patients including the above case (2.9%). In 10 years, asymptomatic restenosis occurred in three patients in addition to the above symptomatic case (restenosis rate 6.1%), and the ipsilateral minor stroke occurred in four patients (6.1%). Carotid endarterectomy with patch graft exerted a high protective effect from restenosis up to 5 and 10 years in our institution. The number of carotid artery stenting is increasing all over the world but we speculated that the established surgical procedure of patched CEA prevented restenosis and ipsilateral stroke.

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Predictors of Restenosis After Carotid Endarterectomy

Abstract: Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.

Cited by 18 publications

References 33 publications

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Covalent modification of pericardial patches for sustained rapamycin delivery inhibits venous neointimal hyperplasia

Racial/Ethnic Variation in Carotid Artery Revascularization Utilization and Outcomes

A Single-center Retrospective Study with 5- and 10-year Follow-up of Carotid Endarterectomy with Patch Graft

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