Risk and outcome profile of carotid endarterectomy with proximal intervention is concerning in multi-institutional assessment

Clouse, W. Darrin; Ergül, Emel; Wanken, Zachary J.; Kleene, Julia; Stone, David H.; Darling, R. Clement; Cambria, Richard P.; Conrad, Mark F.

doi:10.1016/j.jvs.2017.12.069

Cited by 24 publications

(22 citation statements)

References 20 publications

(58 reference statements)

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“…However, the cardiovascular event rate during follow up was high, and warrants intensified follow up of this high risk patient group. If these results are compared with the results of a recently published study, it must be reaffirmed that only 15% of the patients in the study by Clouse et al 10 were treated with this original hybrid approach. Remarkably, all peri-procedural strokes (9.6%) were observed in patients who were treated by the non-original hybrid approach.…”

Section: Discussionmentioning

confidence: 79%

“…The most recently published study reported a clinical follow up of six years and an imaging (only duplex) follow up of three years. 10 The current study is the first reporting imaging follow up data for as long as six years after hybrid revascularisation. In addition, this most recently published study performed the original hybrid approach in only 15% of the patients (n ¼ 9).…”

Section: Discussionmentioning

confidence: 90%

“…In addition, this most recently published study performed the original hybrid approach in only 15% of the patients (n ¼ 9). 10 The other patients were treated by CEA followed by the endovascular procedure. The largest observational study, in which the original hybrid approach was first performed, was published in 2004 4 after which the current study is the largest study in purely symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Remarkably, all peri-procedural strokes (9.6%) were observed in patients who were treated by the non-original hybrid approach. 10 Only in 77% of the patients was cerebral protection by clamping the distal carotid artery during stent placement performed. 10 As such, the present series is the largest series with long-term follow up of the true hybrid intervention for extracranial carotid tandem stenoses.…”

Section: Discussionmentioning

confidence: 99%

“…10 Only in 77% of the patients was cerebral protection by clamping the distal carotid artery during stent placement performed. 10 As such, the present series is the largest series with long-term follow up of the true hybrid intervention for extracranial carotid tandem stenoses. Besides this, the authors stated that flushing manoeuvres are less favourable in clearing the carotid by performing the nonoriginal hybrid approach.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcome of Symptomatic Patients Undergoing Hybrid Revascularisation for Extracranial Carotid Artery Tandem Stenosis

Meershoek

Velde

Toorop

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS This study shows that hybrid revascularisation is feasible and safe in symptomatic patients with an extracranial carotid artery tandem stenosis. This study provides data on purely symptomatic patients including a long-term clinical and imaging follow up period of more than six years. In the future, these surgical outcomes need to be offset against the natural course in patients with a symptomatic carotid tandem lesion. Objectives: Carotid tandem lesions are a multilevel significant (>50%) atherosclerotic disease involving both the internal carotid artery (ICA) and either the ipsilateral common carotid artery (CCA) or the innominate artery (IA). These lesions may be challenging to treat. Current guidelines offer no definitive recommendation on the optimal treatment algorithm. The aim of this analysis was to assess the long-term outcome of patients undergoing surgical revascularisation for tandem lesions. Methods: In two centres, consecutive patients who underwent carotid endarterectomy (CEA) for a symptomatic carotid artery stenosis between 2003 and 2017 were screened retrospectively for the presence of a carotid artery tandem lesion. All eligible patients were treated by a hybrid approach, consisting of retrograde stenting of the proximal CCA or IA followed by CEA. All patients had a yearly clinical check up including duplex ultrasound. The primary outcome was occurrence of any stroke, death, myocardial infarction (MI), or transient ischaemic attack (TIA) within 30 days. Secondary outcomes were any stroke, death, MI, or TIA and occurrence of restenosis 50% during follow up. Results: Sixteen of 2368 symptomatic patients were included. Besides a high grade ICA stenosis, patients had a significant ipsilateral stenosis of the CCA (n ¼ 13) or IA (n ¼ 3). Within 30 days there were no deaths, strokes, or TIAs. Two patients had a clinical MI. During a median follow up of 73 (interquartile range 22e85) months, three patients died. One patient developed a symptomatic restenosis of the ICA (ipsilateral TIA). Two patients (without restenosis) developed an ipsilateral stroke and a MI. Conclusions: In this small case series, hybrid revascularisation of carotid tandem lesions in symptomatic patients seems feasible and safe. Long-term data show a relatively high number of any adverse events. These surgical outcomes need to be offset against the natural course in patients with a symptomatic carotid tandem lesion.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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