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Carotid angioplasty and stenting is safe and effective for treatment of recurrent stenosis after eversion endarterectomy
- Source :
- Journal of Vascular Surgery. 60:645-651
- Publication Year :
- 2014
- Publisher :
- Elsevier BV, 2014.
-
Abstract
- Objective This study was conducted to determine the efficiency and long-term durability of percutaneous transluminal angioplasty and carotid artery stenting in carotid restenosis (CR) treatment after eversion endarterectomy, with emphasis on variables that could influence the outcome. Methods We analyzed 319 patients (220 asymptomatic and 99 symptomatic) who underwent carotid angioplasty from 2002 until 2012 for CR that occurred after eversion endarterectomy. During this period, 7993 eversion endarterectomies were done for significant carotid artery stenosis. Significant CR was detected by ultrasound examination and confirmed by digital subtraction angiography or multidetector computed tomography angiography. After angioplasty (with or without stenting), color duplex ultrasound imaging was done after 1 month, 6 months, 1 year, and annually thereafter. End points encompassed myocardial infarction, stroke, and cardiovascular death (fatal myocardial infarction, fatal cardiac failure, fatal stroke), and also puncture site hematoma and recurrent restenosis. Primary end points were analyzed as early results (≤30 days after the procedure), and secondary end points were long-term results (>30 days). Variables and risk factors influencing the early-term and long-term results were also analyzed. Median follow-up was 49.8 ± 22.8 months (range, 17-121 months). Results All but one procedure ended with a technical success (99.7%). In the early postoperative period, transient ischemic attack occurred in 2.8% of the patients and stroke in 1.6%, followed by one lethal outcome (0.3%). Stent thrombosis occurred in one patient (0.3%) several hours after the angioplasty, followed by urgent surgery and graft interposition. In the long-term follow-up, there were no transient ischemic attacks or strokes, non-neurologic mortality was 3.13%, and the recurrent restenosis rate was 4.4%. The rate of non-neurologic outcomes during the follow-up was significantly higher in asymptomatic patients than in symptomatic patients (4.54% vs 0%; P = .034). The statically highest rate of transient ischemic attack was verified in patients in whom Precise (Cordis Corporation, New Brunswick, NJ) stents was used (12.2%) and a Spider Fx (Covidien, Dublin, Ireland) cerebral protection device (12.5%) was used. Female gender, coronary artery disease, plaque calcifications, and smoking history were associated with an adverse outcome after angioplasty. Conclusions Carotid artery stenting is safe and reliable procedure for CR after eversion endarterectomy treatment, with low rate of postprocedural complications. Type of stent and cerebral embolic protection device may influence the rate of postprocedural neurologic ischemic events.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Myocardial Infarction
610 Medicine & health
Kaplan-Meier Estimate
2705 Cardiology and Cardiovascular Medicine
Coronary artery disease
Restenosis
Recurrence
Risk Factors
Angioplasty
Internal medicine
Multidetector Computed Tomography
medicine
Humans
Carotid Stenosis
Myocardial infarction
Stroke
Aged
Retrospective Studies
Endarterectomy
Endarterectomy, Carotid
Ultrasonography, Doppler, Duplex
business.industry
Angiography, Digital Subtraction
Stent
Middle Aged
medicine.disease
10020 Clinic for Cardiac Surgery
2746 Surgery
3. Good health
Surgery
Stenosis
Treatment Outcome
Ischemic Attack, Transient
Retreatment
Cardiology
Female
Stents
Cardiology and Cardiovascular Medicine
business
Angioplasty, Balloon
Subjects
Details
- ISSN :
- 07415214
- Volume :
- 60
- Database :
- OpenAIRE
- Journal :
- Journal of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....a18b94114b7505c14f860253d6ccfd22