Six hundred consecutive carotid endarterectomies with temporary shunt and vein patch angioplasty: early and long-term results

Scavee, V.; Viejo, Dumet; Buche, Michel; Eucher, Ph.; Louagie, Yves; Haxhe, Jean-Paul; Wispelaere, J-F. De; Trigaux, J-P.; Jamart, Jacques; Schoevaerdts, Jean-Claude

doi:10.1016/s0967-2109(01)00045-x

Cited by 16 publications

(17 citation statements)

References 30 publications

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“…These data are consistent with recent studies of Ͼ500 carotid endarterectomies that demonstrate 30-day major stroke and death rates ranging from 0.9% to 4% and a restenosis rate of 0.7% to 7.9% over an average of 3.5 years (Table 2). [5][6][7][8][9][10][11][12] The present study demonstrating a 0.1% critical restenosis rate provides the longest follow-up data available to date and confirms that carotid endarterectomy is an extremely durable operation.…”

Section: Discussionsupporting

confidence: 75%

“…The preponderance of data indicates that restenosis rates are generally lower with patch closure of the arteriotomy than with primary closure, ranging from 0.1% to 5.8% and 1% to 14%, respectively. [5][6][7][8][9][10][11][12] …”

Section: Discussionmentioning

confidence: 99%

“…4 An ample number of independent surgical series support this contention. [5][6][7][8][9][10][11][12] In addition to a low perioperative complication rate, the risk of recurrent stenosis or late postoperative stroke is favorable. [13][14][15][16] Recently, carotid angioplasty has emerged as a potential alternative treatment for extracranial carotid occlusive disease.…”

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confidence: 99%

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Durability of Carotid Endarterectomy

Ecker

Pichelmann

Meissner

et al. 2003

Stroke

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Background and Purpose-We sought to determine the incidence of recurrent stenosis after carotid endarterectomy. Methods-One thousand consecutive carotid endarterectomy patients were followed prospectively. The surgery was performed in a standard fashion. Cerebral protection was provided with intraoperative electroencephalographic monitoring and selective shunting. All arteriotomies were repaired with a patch graft. Each patient was seen 3 months after surgery and then yearly, with a duplex ultrasound obtained at each visit. Evidence for new ischemic events or recurrent stenosis of Ն70% was recorded. Results-The 30-day combined minor and major stroke and death rate was 1.9%. At 7.1-year follow-up, 0.1% of patients had recurrent stenosis Ն70%, the majority of which were asymptomatic. Conclusions-Carotid endarterectomy is a low-risk procedure for the treatment of carotid occlusive disease, with excellent long-term durability. Although less invasive, carotid angioplasty must demonstrate equal robustness in long-term follow-up before it is considered a routine alternative to surgery.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Durability of Carotid Endarterectomy

Ecker

Pichelmann

Meissner

et al. 2003

Stroke

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“…6 However, other studies with at least one-third of the patients operated on for an asymptomatic stenosis demonstrated far better survival with 92% to 93% at 5 years and 87% to 89% at 10 years. 5,7 Long-term survival in the randomized trials is not yet available, in ACAS mean follow-up was 2.6 years and in ACST there is an ongoing long-term follow-up. 1,2 These awaited results will probably provide further information on this matter, including the stroke-free survival, which was not possible to assess in this study, because stroke Ͼ30 days after surgery is not reported to the Swedvasc.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2] Long-term follow-up after CEA for asymptomatic stenosis is not well-documented, 3-4 most reports have not analyzed outcome selectively for different indications. [5][6][7] Some natural history studies of patients with asymptomatic stenosis present risk factors, stroke and survival rates beyond 5 years, but differ in selection of study groups. 8 -10 The patients included in the majority of these studies often have a mean age of Ϸ70 years, and although the durability of CEA is good, the overall long-term mortality is also essential in decision-making for this prophylactic procedure.…”

mentioning

confidence: 99%

Long-Term Survival After Carotid Endarterectomy for Asymptomatic Stenosis

Kragsterman

Björck

Lindbäck

et al. 2006

Stroke

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Background and Purpose— Large randomized trials have demonstrated a net benefit of carotid endarterectomy (CEA) for asymptomatic carotid artery stenosis compared with best medical treatment. However, it takes years to overcome the perioperative risk and gain the reduction in stroke or death risk. Long-term survival after CEA for asymptomatic stenosis may be an important consideration in deciding on this prophylactic procedure, but is not well documented. The aim was to analyze long-term survival after CEA for asymptomatic stenosis and the impact of risk factors in a population-based study. Methods— The Swedish vascular registry (Swedvasc) covers all centers performing CEA. Data on all registered CEAs during 1994 to 2003 were retrieved. All patients were cross-matched with the Population-Registry for accurate data on mortality (date of death). Analyses with Kaplan-Meier curves for survival and relative odds ratio (OR) for predictors of survival were performed. Results— A total of 6169 CEAs in 5808 patients were registered, with a median time at risk of 5.1 (range, 0.1 to 11.8) years. The indication for CEA was asymptomatic stenosis in 10.8% of the patients. Survival after CEA for asymptomatic stenosis was 78.2% after 5 and 45.5% after 10 years. Previous vascular surgery (OR, 1.8; 1.1 to 3.0), cardiac disease (OR, 1.7; 1.0 to 2.8), diabetes mellitus (OR, 2.3; 1.3 to 4.1), and age (OR, 1.5; 1.1 to 2.1 per 10 years) were predictors of decreased 5-year survival. Conclusions— In this population-based study of patients operated on for asymptomatic stenosis, a substantial reduction in long-term survival was observed. Predictors of decreased longevity were age at operation, diabetes, cardiac disease, and previous vascular surgery.

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