High rate of restenosis after carotid artery stenting in patients with high-grade internal carotid artery stenosis. Medium-term follow-up.
OBJECTIVE
Carotid endarterectomy (CEA) is the gold-standard procedure for the majority of patients with high-grade symptomatic internal carotid artery stenosis and also for specified high-grade asymptomatic stenoses; however, a proportion of patients are treated with carotid endovascular therapy. We aimed to document medium-term clinical and neurosonographical outcome after carotid artery stenting (CAS).


METHODS
53 patients (mean age: 65 +/- 8 years) with high-grade (> or = 70 % by means of duplex sonography) carotid artery stenosis were enrolled into the study. Nineteen patients had asymptomatic, 34 patients had symptomatic stenoses. All patients had a pre-interventional CT, Doppler and duplex sonography, and digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) prior to the procedural DSA. All patients were offered CEA as the gold-standard procedure and as an alternative to CAS. Both clinical and Duplex sonographical follow-up was obtained at day 1 and 7, month 1, month 3, month 6, month 12, and every subsequent 6 months after the procedure. Mean follow-up time was 22 +/- 1.6 months (+/- SEM).


RESULTS
2/53 patients suffered from stroke. A further 2 patients suffered from carotid artery occlusion shortly after CAS. The cumulative rate of restenosis during follow-up was 24.5 % (13/53). Four of these (7.5 %) were of high-grade and led to further interventional or surgical therapy.


CONCLUSIONS
A high rate of restenosis was found during follow-up after CAS. Our analysis of non-selected patients emphasizes that CEA remains the gold-standard procedure for the treatment of symptomatic internal carotid artery stenosis. The frequently performed endovascular treatment of carotid stenosis outside the setting of a randomized controlled trial is not supported by our data.
Harrer
Judith U
JU
Neurological Clinic, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. Judith.Harrer@web.de
Morschel
Ralf
R
Mull
Michael
M
Kosinski
Christoph M
CM
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods