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CAS shows promise in recurrent restenosis after CEA
In a population of patients with recurrent stenosis after carotid endarterectomy, carotid artery stenting was both a safe and feasible therapeutic strategy, according to new long-term data.
The retrospective review included all 385 patients (mean age, 68.6 ± 9.6 years; 60% men) who underwent 435 carotid artery stenting (CAS) procedures at a single center from 1999 to 2013. Researchers stratified patients based on whether the lesion was de novo or post-carotid endarterectomy (CEA) restenosis. Outcome measures were target vessel reintervention (TVR) and in-stent restenosis (ISR).
Among patients in the CAS restenosis arm, the mean time between CEA and CAS procedures was 72.4 ± 63.6 months.
Severe carotid stenosis, defined as 70% to 99%, was the main indication for initial carotid angiography with possible revascularization in both the de novo (83.7%) and restenosis (83.6%) groups.
Researchers reported no significant between-group differences in the rates of postintervention residual stenosis (< 30%), complications, in-hospital stroke, MI or death.
Mean follow-up was 62.4 ± 45.6 months. The mean clinical/TVR follow-up was greater for the restenosis group compared with the de novo group (71.9 months vs. 53.3 months; P < .001).
Both groups were further stratified depending on whether patients were symptomatic or asymptomatic. Among these four subgroups, data indicated no differences in freedom for ISR (P = .174) or TVR (P = .856).
In multivariate analysis, peripheral vascular disease independently predicted ISR (HR = 1.92; P = .041), whereas the predictors of TVR included age younger than 65 years at the time of the procedure (HR = 2.55; P = .039) and peripheral vascular disease (HR = 2.46; P = .043).
“The current study provides the first long-term outcome analysis of carotid angioplasty after CEA vs. de novo CAS,” the researchers wrote. “The study supports previous shorter term or small sample size trials suggesting that CAS is a safe and feasible therapeutic option in patients with recurrent stenosis following CEA.” – by Brian Ellis
Disclosure: The researchers report no relevant financial disclosures.