PP14. In-stent Restenosis after Carotid Angioplasty and Stenting: Post-Carotid Endarterectomy Lesions Fare Equally as Well as True De Novo Lesions

Article Outline

• Objectives
• Methods
• Results
• Conclusion
• Copyright

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Objectives 

Restenosis following carotid endarterectomy (CEA) can be treated with carotid angioplasty and stenting (CAS), but concerns about durability exist. Data for CAS restenosis following CEA is limited and conflicting and includes arteries that have been radiated. The disease process of radiated arterial restenosis is different. We compare the long-term results of CAS performed after ipsilateral CEA to results of CAS for true de novo carotid stenosis.

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Methods 

269 consecutive CAS procedures between January 2003 and August 2008 were performed on 254 patients. 18 patients were excluded for neck radiation therapy to represent true de novo lesions for comparison. Seventy four procedures were performed for post-CEA indication and 173 procedures for de novo lesions. Standard statistical analysis was used. In-stent restenosis was defined as > 50% stenosis using duplex ultrasound internal carotid artery peak systolic velocity ≥220 centimeters per second (cm/s) and internal to common carotid artery peak systolic velocity ratio ≥2.7.

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Results 

Mean age was 73 years (range: 43.7-90.4). 55% were male and 45% female. Caucasians comprised 90% and African-Americans 8%. Mean follow-up was 13.1 months (range, 0-63.4). Demographic information and risk factors were similar except for age (73.8 years de novo versus 71.1 years post-CEA; p=0.035), smoking (62% post-CEA versus 42% de novo; p=0.004), symptomatic (27% post-CEA versus 45% de novo; p=0.008), and embolic protection use (92% post-CEA versus 99% de novo; p=0.001). Overall, 30-day risk of stroke was 3.2%, death was 1.2%, and myocardial infarction was 0.8% with no group differences (p=0.273, p=0.53, and p=0.16, respectively. Three year overall survival was not significant: de novo group at 75% compared to 53% for post-CEA group (p=0.074). At four years the overall freedom from stroke was 96% with no group difference (p=0.19). Primary patency at three years was similar, 89% for post-CEA and 91% for the de novo group (p=0.211). Only 3 patients (p=NS) had duplex ultrasound criteria indicative of >80% stenosis, none required reintervention.

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Conclusion 

There is not an increased rate of in-stent restenosis following CAS for post-CEA restenosis compared to non-radiated true de novo lesions.