Safety, Efficacy, and Durability of Carotid Artery Stenting for Restenosis Following Carotid Endarterectomy: A Multicenter Study

New, Gishel; Roubin, Gary S.; Iyer, Sriram S.; Vitek, Jiri J.; Wholey, Mark H.; Diethrich, Edward B.; Hopkins, L. Nelson; Hobson, Robert W.; Leon, Martin B.; Myla, Subbarao; Shawl, Fayaz A.; Ramee, Stephen R.; Yadav, Jay S.; Rosenfield, Kenneth; Liu, Ming W.; Gomez, Camilo R.; Al-Mubarak, Nadim; Gray, William A.; Tan, Walter A.; Goldstein, Jonathan; Stack, Richard S.

doi:10.1583/1545-1550(2000)007<0345:seadoc>2.0.co;2

Cited by 70 publications

(69 citation statements)

References 39 publications

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“…For the moment, only a few series of cases with long-term follow-up after CAS have been reported, [6][7][8][9]30 and no studies have analyzed the behavior of the implanted stent over time on the basis of the different stent materials.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, these trials did neglect to publish longterm results after CAS, and only a few nonrandomized studies have focused their attention on long-term results with Ͼ5 years of follow-up. [5][6][7][8][9] As demonstrated by several RCTs comparing the efficacy of CEA vs medical therapy, even after successful carotid revascularization late ipsilateral stroke occurs in 5.1-13% at 5 years. [10][11][12][13][14] The major concern for long-term results after CAS is, therefore, that the plaque, which is completely removed in CEA surgery, is only remodeled and contained behind the strut of the stent, so that the only protection against late embolization is the scaffolding of the emboligenic plaque by means of the stent.…”

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Long-term results of carotid artery stenting

Donato

Setacci

Deloose

et al. 2008

Journal of Vascular Surgery

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Objective: Data regarding the long-term efficacy of carotid artery stenting (CAS) are still scarce. As demonstrated by several major randomized controlled trials (RCT) comparing the efficacy of carotid endarterectomy (CEA) vs medical therapy, even after successful carotid revascularization late ipsilateral stroke occurs in 5-13% at 5 years. Therefore, major concerns also remain about the durability of the CAS procedure in terms of stroke prevention. The purpose of this study was to review long-term results after carotid stent implantation in a large cohort of patients. Methods: This retrospective investigation involved 3179 CAS procedures performed at four European carotid highvolume centers. Echo-duplex scan using modified velocity criteria to recognize in-stent restenosis (ISR) and neurological examinations of all patients were carried out every 6 months after the procedure. Life-table analysis was used to determine freedom from mortality, stroke-related death, ipsilateral fatal/major stroke, and any ipsilateral stroke. Freedom from ISR and from reintervention were also reported. The secondary aim was to identify predictive risk factors for neurological complications and ISR. Results: At 5 years freedom from mortality, stroke-related death, ipsilateral fatal/major stroke, and any stroke rate were 82%, 93.5%, 93.3%, and 91.9%, respectively. The only predictor for neurological complications was the presence of neurological symptoms before CAS (hazard ratio 1.38 [CI 1.05, 1.82] P ‫؍‬ .02). Freedom from restenosis at 1, 3, and 5 years was, respectively, 98.4%, 96.1%, and 94%. Uni-and multi-variate analyses showed that stent characteristics (material/design/freecell area) were not significantly associated with time to in-stent restenosis or time to reintervention. Conclusion: Our long-term results in a large cohort of patients validated CAS as a durable procedure for stroke prevention. The annual rate of neurological complications after CAS was comparable to that of conventional surgery as demonstrated by large RCTs involving both symptomatic patients (North American Symptomatic Carotid Endarterectomy Trial [NASCET] and European Carotid Surgery Trial [ECST]) and asymptomatic patients (Asymptomatic Carotid Atherosclerosis Study [ACAS] and Asymptomatic Carotid Surgery Trial [ACST]). ( J Vasc Surg 2008;48:1431-41.)In recent years, carotid artery stenting (CAS) has rapidly gained recognition worldwide as a possible alternative to carotid endarterectomy (CEA). Although excellent results from centers with a high-volume experience seem to demonstrate that CAS is technically feasible and safe, 1 the few randomized controlled trials (RCTs) conducted so far have not clarified the equivalence of this technique compared to CEA in terms of early results 2-4 in normal-risk patients. Moreover, these trials did neglect to publish longterm results after CAS, and only a few nonrandomized studies have focused their attention on long-term results with Ͼ5 years of follow-up. [5][6][7][8][9] As demonstrated by several RCTs comparing the ...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Long-term results of carotid artery stenting

Donato

Setacci

Deloose

et al. 2008

Journal of Vascular Surgery

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“…[1][2][3][4] The incidence of carotid in-stent restenosis has been reported to vary between 1% and 50%. [1][2][3][4][5] This variation has been attributed to several factors, including the method of stenosis calculation, the definition of severity of stenosis, and the duration of followup.…”

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confidence: 99%

Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis

AbuRahma

Abu-Halimah

Bensenhaver

et al. 2008

Journal of Vascular Surgery

126

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“…The data presented relate to patient with restenosis after CEA in comparison to patients with primary-stenotic lesions. There are two rationales for emphasis on post-CEA restenosis: First, restenosis after CEA is well known and found in 3-21% of patients [25][26][27]; it seems that PTCA and stenting can be the preferred treatment for this category of patients [28][29][30]. Second, embolization during PTCA and stenting in patients with post-CEA restenosis can differ in comparison with primary ICA stenosis because of the different pathophysiological mechanisms underlying the stenosis formation.…”

Section: Discussionmentioning

confidence: 99%

Microemboli at the different stages of percutaneous transluminal carotid angioplasty and stenting in patients with post–carotid endarterectomy restenosis compared to primary stenosis

Telman¹,

Halabi²,

Kouperberg³

et al. 2011

Int J Angiol

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Microembolization to cerebral arteries during percutaneous transluminal carotid angioplasty (PTCA) and stenting is well described, as well as different mural pathology in primary versus post-carotid endarterectomy (CEA) restenosis lesions. The purpose of this study is to investigate possible different patterns of embolization in regards to number and distribution of microembolic signals (high-intensity transient signals (HITS)) in patients with primary carotid stenosis and restenosis after CEA. We used transcranial Doppler (TCD) to monitor the ipsilateral middle cerebral artery (MCA) of 13 patients (13 procedures) with restenosis after CEA and six patients (seven procedures) with primary stenosis of the internal carotid artery (ICA) during PTCA and stenting. All the procedures were performed without protection devices. The total number of HITS recorded in all patients was 2692, including 1563 microemboli in patients with restenosis and 1129 in patients with primary stenosis. The mean number of microemboli per procedure was 120.2 ± 65 and 161.3 ± 70 (p = 0.05) respectively. The average number of microembolic signals during the various stages of PTCA and stenting in the two groups was as follows: 1. Crossing the stenotic region with the guidewire and positioning the balloon inside the stenosis 33 ± 6.9 and 73.4 ± 9.4 (restenosis patients versus primary-stenosis patients, respectively,

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Safety, Efficacy, and Durability of Carotid Artery Stenting for Restenosis Following Carotid Endarterectomy: A Multicenter Study

Cited by 70 publications

References 39 publications

Long-term results of carotid artery stenting

Long-term results of carotid artery stenting

Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis

Microemboli at the different stages of percutaneous transluminal carotid angioplasty and stenting in patients with post–carotid endarterectomy restenosis compared to primary stenosis

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