EFFECT OF AGGRESSIVE LIPID THERAPY ON PROGRESSION OF CAROTID ARTERY STENOSIS: A LONGTERM FOLLOW UP STUDY

Background: Carotid artery stenosis is an important cause for stroke. Carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic carotid stenosis and to some extent in patients with asymptomatic carotid stenosis. More than 20 years ago, carotid artery stenting (CAS) emerged as an endovascular treatment alternative to CEA. Objective and Methods: This review summarises the available evidence from randomised clinical trials in patients with symptomatic as well as in patients with asymptomatic carotid stenosis. Results: CAS is associated with a higher risk of death or any stroke between randomisation and 30 days after treatment than CEA (odds ratio (OR) = 1.74, 95% CI 1.3 to 2.33, p < 0.0001). In a pre-defined subgroup analysis, the OR for stroke or death within 30 days after treatment was 1.11 (95% CI 0.74 to 1.64) in patients <70 years old and 2.23 (95% CI 1.61 to 3.08) in patients ≥70 years old, resulting in a significant interaction between patient age and treatment modality (interaction p = 0.007). The combination of death or any stroke up to 30 days after treatment or ipsilateral stroke during follow-up also favoured CEA (OR = 1.51, 95% CI 1.24 to 1.85, p < 0.0001). In asymptomatic patients, there is a non-significant increase in death or stroke occurring within 30 days of treatment with CAS compared to CEA (OR = 1.72, 95% CI 1.00 to 2.97, p = 0.05). The risk of peri-procedural death or stroke or ipsilateral stroke during follow-up did not differ significantly between treatments (OR = 1.27, 95% CI 0.87 to 1.84, p = 0.22). Discussion and Conclusion: In symptomatic patients, randomised evidence has consistently shown CAS to be associated with a higher risk of stroke or death within 30 days of treatment than CEA. This extra risk is mostly attributed to an increase in strokes occurring on the day of the procedure in patients ≥70 years. In asymptomatic patients, there may be a small increase in the risk of stroke or death within 30 days of treatment with CAS compared to CEA, but the currently available evidence is insufficient and further data from ongoing randomised trials are needed.

Download Full-text

Percutaneous transluminal angioplasty and stenting for recurrent carotid artery stenosis

Neurosurgical FOCUS ◽

10.3171/foc.1998.5.6.8 ◽

1998 ◽

Vol 5 (6) ◽

pp. E7

Author(s):

Giuseppe Lanzino ◽

Robert A. Mericle ◽

Demetrius K. Lopes ◽

Ajay K. Wakhloo ◽

Lee R. Guterman ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Artery Stenosis ◽

Cardiac Complications ◽

Neurological Event ◽

Angioplasty And Stenting ◽

Percutaneous Transluminal

Percutaneous transluminal angioplasty (PTA) and stenting has recently been proposed as an alternative to surgical reexploration in patients with recurrent carotid artery stenosis following endarterectomy. The authors retrospectively reviewed their experience after performing 25 procedures in 21 patients to assess the safety and efficacy of PTA with or without stenting for carotid artery restenosis. The mean interval between endarterectomy and the endovascular procedure was 57 months (range 8-220 months). Seven arteries in five patients were treated by PTA alone (including bilateral procedures in one patient and repeated angioplasty in the same vessel in another). Early suboptimum results and recurrent stenosis in some of these initial cases prompted the authors to combine PTA with stenting in the treatment of 18 arteries over the past 3 years. No major periprocedural deficits (neurological or cardiac complications) or death occurred. There was one periprocedural transient neurological event. A pseudoaneurysm of the femoral artery (at the access site) required surgical repair. In the 16 patients who each underwent at least 6 months of follow-up review, no neurological events ipsilateral to the treated artery had occurred after a mean follow-up period of 27 months (range 6-57 months). Three of five patients who underwent PTA alone developed significant (> 50%) asymptomatic restenoses that required repeated angioplasty in one and PTA with stenting in two patients. Significant restenosis (55%) was observed in only one of the vessels treated by combined angioplasty with stenting. Endovascular PTA and stenting of recurrent carotid artery stenosis is both technically feasible and safe and has a satisfactory midterm patency. This procedure can be considered a viable alternative to surgical reexploration in patients with recurrent carotid artery stenosis.

Download Full-text

AS-54: Sex as an Independent Risk Factor for Adverse Events following Carotid Stenting for Carotid Artery Stenosis: Acute and Long-Term Follow-Up Results

The American Journal of Cardiology ◽

10.1016/j.amjcard.2009.01.099 ◽

2009 ◽

Vol 103 (9) ◽

pp. 25B

Author(s):

Chung-Ho Hsu ◽

Jen-Jyh Lin ◽

Ping-Han Lo ◽

Kuan-Chen Chang ◽

Jui-Sung Hung

Keyword(s):

Risk Factor ◽

Carotid Artery ◽

Adverse Events ◽

Carotid Artery Stenosis ◽

Independent Risk Factor ◽

Carotid Stenting ◽

Artery Stenosis ◽

Long Term Follow Up

Download Full-text

Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis

10.1093/med/9780199384075.003.0007 ◽

2017 ◽

Author(s):

Clint S. Schoolfield ◽

Wayne W. Zhang ◽

Tze-Woei Tan

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Perioperative Period ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Patients ◽

Increased Risk ◽

Asymptomatic Carotid Artery Stenosis ◽

Study Intervention

This chapter provides a summary of the landmark CREST study that compared carotid endarterectomy (CEA) and carotid artery stenting (CAS) for patients with symptomatic or asymptomatic carotid artery stenosis. The study found that the combined overall rate of stroke, myocardial infarction (MI) or death between CEA and CAS did not differ significantly in symptomatic or asymptomatic patients. However, during the perioperative period, CAS was associated with an increased risk of stroke and CEA was associated with an increased risk of MI. The chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Download Full-text