Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: Systematic review and meta-analysis

Tu, Jian; Wang, Siwen; Huo, Zijun; Wu, Ridong; Yao, Chen; Wang, Shenming

doi:10.1016/j.surg.2015.02.005

Cited by 27 publications

(18 citation statements)

References 57 publications

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“…21 Following the study by Spinelli et al, 3 our series showed comparable results when PTFE was used for repeated carotid revascularization with freedom from stroke of 93% at 5 years, a finding in agreement with the previous reports. Conversely, use of the GSV as a carotid substitute has been associated with a high rate of restenosis, 1,21,22 with cumulative freedom from occlusion or recurrent stenosis >70% of 83% at 5 years 23 compared with 93% in our series.…”

Section: Discussioncontrasting

confidence: 52%

“…18,19 A summary of the outcomes in recent series of CEA, CAS, or PCB for carotid restenosis is given in Table II. Taking into account the material used in carotid bypass, the great saphenous vein (GSV) or a PTFE graft can be chosen. 1,9,20 PTFE carotid bypasses have been shown to yield excellent postoperative and long-term outcomes when carried out as an elective alternative to CEA. 21 Following the study by Spinelli et al, 3 our series showed comparable results when PTFE was used for repeated carotid revascularization with freedom from stroke of 93% at 5 years, a finding in agreement with the previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of significant recurrent carotid artery stenosis $70% after primary carotid endarterectomy (CEA) and after carotid artery stenting (CAS) varies from 0.6% to 15%. [1][2][3][4] Restenosis may result from intimal hyperplasia, usually within 24 months of the primary operation, or from recurrent atherosclerosis beyond this time interval. 5 Symptoms of cerebral ischemia are present in up to 5% of the patients.…”

mentioning

confidence: 99%

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Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Belmonte

Schneider

Pizzardi

et al. 2017

Journal of Vascular Surgery

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Belmonte

Schneider

Pizzardi

et al. 2017

Journal of Vascular Surgery

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“…66 Redo CEA has an increased potential for CNIs and also carries an increased stroke risk compared with primary CEA. 67 CNIs were more common with CEA, but recurrent restenosis was more common with CAS (both P < 0.05). A systematic review and meta-analysis of 4399 patients from 50 studies reported no differences in 30-day rates of stroke/TIA/MI or long-term stroke rates between CAS and CEA groups for patients with restenosis.…”

Section: Previous Ceamentioning

confidence: 93%

“…A systematic review and meta-analysis of 4399 patients from 50 studies reported no differences in 30-day rates of stroke/TIA/MI or long-term stroke rates between CAS and CEA groups for patients with restenosis. 67 CNIs were more common with CEA, but recurrent restenosis was more common with CAS (both P < 0.05).…”

Section: Previous Ceamentioning

confidence: 93%

Carotid artery stenting: Current state of evidence and future directions

et al. 2019

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Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) are common treatments for carotid artery stenosis. Several randomized controlled trials (RCTs) have compared CEA to CAS in the treatment of carotid artery stenosis. These studies have suggested that CAS is more strongly associated with periprocedural stroke; however, CEA is more strongly associated with myocardial infarction. Published longterm outcomes report that CAS and CEA are similar. A reduction in complications associated with CAS has also been demonstrated over time. The symptomatic status of the patient and history of previous CEA or cervical radiotherapy are significant factors when deciding between CEA or CAS. Numerous carotid artery stents are available, varying in material, shape and design but with minimal evidence comparing stent types. The role of cerebral protection devices is unclear. Dual antiplatelet therapy is typically prescribed to prevent in-stent thrombosis, and however, evidence comparing periprocedural and postprocedural antiplatelet therapy is scarce, resulting in inconsistent guidelines. Several RCTs are underway that will aim to clarify some of these uncertainties. In this review, we summarize the development of varying techniques of CAS and studies comparing CAS to CEA as treatment options for carotid artery stenosis. K E Y W O R D Scarotid artery atherosclerosis, carotid artery stenosis, carotid artery stenting, carotid endarterectomy, stroke, stroke prevention | 319 LAMANNA et AL.

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Risks Associated With Primary and Redo Carotid Endarterectomy in the Endovascular Era

et al. 2018

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IMPORTANCE Clinical experience suggests worse outcomes for redo carotid endarterectomy (CEA) relative to primary CEA. Objective quantification of the excess risk attributable to redo CEA in this era of proliferating endovascular therapy remains to be determined. OBJECTIVE To evaluate the risks of redo CEA relative to primary CEA. DESIGN, SETTING, AND PARTICIPANTSThis study was a retrospective analysis of a prospective cohort of patients maintained by the Society for Vascular Surgery in the Vascular Quality Initiative between January 1, 2003, and April 30, 2016. The setting was consecutive patients from academic and community hospitals across the United States. Participants were patients who underwent primary CEA or redo CEA for symptomatic or asymptomatic carotid stenosis.EXPOSURES Primary CEA and redo CEA.MAIN OUTCOMES AND MEASURES Stroke, death, myocardial infarction, stroke or death, and stroke, death, or myocardial infarction at 30 days and 1 year. RESULTS There were 64 118 CEAs recorded, including 62 749 primary CEAs (97.9%) (median age, 71 years; 39.5% female) and 1369 redo CEAs (2.1%) (median age, 71 years; 42.2% female). Comparing primary CEA vs redo CEA, the incidence of 30-day stroke was 0.7% vs 1.9% (P < .001) for asymptomatic patients and 1.5% vs 1.4% (P = .77) for symptomatic patients for an overall 0.9% vs 1.8% (P = .002). Incidences were 0.8% vs 1.3% (P = .09) for perioperative myocardial infarction, 0.6% vs 1.4% (P = .003) for death, and 1.5% vs 2.6% (P = .001) for stroke or death. Risk-adjusted 30-day stroke (odds ratio [OR], 2.82; 95% CI, 1.69-4.71; P < .001), death (OR, 2.15; 95% CI, 1.21-3.79; P = .009), and stroke or death (OR, 2.06; 95% CI, 1.32-3.23; P = .002) were higher for redo CEA compared with primary CEA among asymptomatic patients but were similar among symptomatic patients for stroke (OR, 0.79; 95% CI, 0.33-1.95; P = .62), death (OR, 1.32; 95% CI, 0.53-3.26; P = .55), and stroke or death (OR, 0.85; 95% CI, 0.39-1.82; P = .68). Stroke or death at 1 year among asymptomatic patients was higher for redo CEA (hazard ratio [HR], 1.36; 95% CI, 1.08-1.69; P = .009) but was similar among symptomatic patients (HR, 0.94; 95% CI, 0.67-1.31; P = .71). CONCLUSIONS AND RELEVANCEThe outcomes of redo CEA and primary CEA fall within the professional guidelines for carotid revascularization. However, redo CEA is associated with a 2.8 times increase in the risk of stroke and a 2.2 times increase in the risk of death compared with primary CEA among asymptomatic patients. There is no significant difference in outcomes among symptomatic patients. These redo CEA and primary CEA results should inform patient and clinician expectations at the point of care.

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Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: Systematic review and meta-analysis

Cited by 27 publications

References 57 publications

Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery

Carotid artery stenting: Current state of evidence and future directions

Risks Associated With Primary and Redo Carotid Endarterectomy in the Endovascular Era

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