Background Carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS) are widely practiced methods for primary and secondary stroke prevention in patients with carotid stenosis. Although existing trials have provided valuable data regarding perioperative and intermediate-term outcomes, further data is needed to refine patient selection and long-term management.
Methods This was a single-center retrospective review of CEA and CAS cases performed by our neurovascular service. Patient and procedural characteristics and clinical and radiographic outcomes were recorded. Cumulative restenosis rates were calculated using the Kaplan-Meier survival method. A multiple regression model was constructed using Cox proportional hazards regression with forward stepwise inclusion, utilizing the following co-variates: CEA (vs. CAS), side of procedure, symptomatic presentation, preoperative peak systolic velocity (PSV), near-complete occlusion, postoperative PSV, age, sex, previous stroke or transient ischemic attack, hypertension, diabetes mellitus, heart disease, dyslipidemia, and smoking.
Results A total of 317 cases were included – 204 CEA and 113 CAS. Median follow-up duration was 353 days (interquartile range 50.5–856.5). Restenosis occurred in a total of 23 cases (17 CEA and 6 CAS), yielding cumulative restenosis rates of 8%, 10%, and 14% at one, three, and five years, respectively. Eleven of these patients underwent ipsilateral re-operation, and the remaining twelve were observed with serial imaging. After stepwise regression, only a single variable remained significant: postoperative PSV (hazard ratio 1.005 per cm/s; p=0.035). The median postoperative PSV was 133 cm/s in patients who developed restenosis, and 114 cm/s in those who did not.
Conclusions The restenosis rates following CEA and CAS in this single-center, ‘real-world’ experience were similar to those from randomized controlled trials. Most cases of restenosis occurred within the first year. A higher PSV Doppler measurement obtained in the immediate postoperative period was predictive of restenosis during follow-up. Patients whose PSV remains elevated immediately after revascularization may warrant closer follow-up.
Disclosures A. Witek: None. B. Howie: None. G. Toth: None.
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