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  • Cumulative incidence of restenosis in the endovascular treatment of extracranial carotid artery stenosis: a meta-analysis

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Head and Neck
Original research
Cumulative incidence of restenosis in the endovascular treatment of extracranial carotid artery stenosis: a meta-analysis
  1. Pierre Clavel1,
  2. Solène Hebert2,
  3. Suzana Saleme1,
  4. Charbel Mounayer1,3,
  5. Aymeric Rouchaud1,3,
  6. Benoit Marin4,5,6
  1. 1 Service de Radiologie, CHU Limoges, Limoges, France
  2. 2 Service de Neurologie, CHU Limoges, Limoges, France
  3. 3 CNRS, XLIM, UMR 7252, Univ. Limoges, Limoges, France
  4. 4 CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
  5. 5 Tropical Neuroepidemiology, INSERM, UMR1094, Limoges, France
  6. 6 Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Univ. Limoges, UMR_S 1094, Limoges, France
  1. Correspondence to Dr Pierre Clavel, Service de radiologie, CHU Limoges, Limoges 87000, France; pierreclavel{at}hotmail.fr

Abstract

Objective To assess the cumulative incidence of restenosis and stroke after stenting for cervical carotid artery stenosis.

Methods We reviewed PubMed, ScienceDirect, and Scopus and included all studies reporting restenosis after stenting. The cumulative incidence of restenosis at 6 and 12 months was calculated. We also estimated the cumulative incidence of ipsilateral stroke within 30 days after stenting. Random effect meta-analysis and meta-regression were performed using relevant study level covariates. Sources of heterogeneity were investigated.

Results Among 7765 records, 40 studies were selected. 15 943 patients and 16 337 carotid arteries were considered. The overall pooled cumulative incidence of restenosis >50% at 12 months was 5.7% (95% CI 3.8% to 8.6%), >70% at 12 months was 5.2% (95% CI 3.3% to 8.2%), >50% at 6 months was 3.9% (95% CI 2.2% to 6.8%), and ipsilateral stroke within 30 days after stenting was 1.6% (95% CI 1.0% to 2.5%) without association with the use of an embolic protection device. We did not identify any relevant source of heterogeneity of the cumulative incidence of restenosis >50% at 12 months. Mean age explained 80.9% (R2=80.9%, p=0.01) of heterogeneities of restenosis >70% at 12 months. The presence of hostile neck explained 53.9% (R2=53.9%, p=0.03) of heterogeneities of restenosis >50% at 6 months.

Conclusion This meta-analysis showed a low cumulative rate of restenosis at 12 months and ipsilateral stroke within 30 days after stenting. Older patients and those with hostile neck present a lower risk of in-stent restenosis. The use of an embolic protection device was not associated with a lower risk of stroke.

  • restenosis
  • extra cranial carotid
  • stent
  • cumulative incidence
  • endovascular

https://doi.org/10.1136/neurintsurg-2018-014534

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    Footnotes

    • AR and BM contributed equally.

    • Contributors Study design: BM, PC, SH, CM, AR, SS. Data collection: PC, SH. Statistical analysis: BM, PC. Critical review: BM, PC, SH, CM, AR, SS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.