Carotid artery interventions for restenosis after prior stenting: is it different from interventions of de novo lesions? Results from the carotid artery stent (CAS)--registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK).
OBJECTIVE
To compare characteristics and outcome of patients with re-stenoses after prior carotid artery stenting (CAS) treated with repeat carotid interventions (Re-CI) with CAS for de novo lesions.


BACKGROUND
The treatment of re-stenosis is a major problem in vascular interventions. Patients with re-stenoses after prior CAS treated with Re-CI are not well defined.


METHODS
We analyzed data from the prospective ALKK CAS Registry.


RESULTS
Out of 3,817 CAS procedures 95 were intended in 93 patients (2.5%) for a restenosis after prior CAS and 3,722 CAS in 3,655 patients (97.5%) for a de novo stenosis. There was no difference in age (p = 0.302) or distribution of gender (p = 0.545) between the two groups. Patients treated for a restenosis after CAS were less likely to be treated for a symptomatic lesion (22.7 vs. 40.1%, p = 0.001). Coronary heart disease (p = 0.017), peripheral arterial disease (p < 0.001) as well as diabetes mellitus (p = 0.004) were more prevalent in the restenosis group. Lesions were less complicated in restenosis patients, with less ulcers (7.4 vs. 19.9%, p = 0.003) and less severe calcifications (7.4 vs. 23.6%, p < 0.001). The intended interventions were more often not performed in the Re-CI group (9.5 vs. 3.3%; p = 0.001). In-hospital, the stroke or death rate was 0% in the Re-CI group as compared to 3.1% in the de novo group (p = 0.115).


CONCLUSIONS
Patients treated with Re-CI for repeat stenoses after prior CAS represent 2.5% of current CAS patients. Although representing a subgroup with more concomitant diseases, Re-CI seems to be associated with lower event rates as compared to CAS for de novo lesions.
Zahn
Ralf
R
Herzzentrum Ludwigshafen, Kardiologie, Bremserstraße 79, 67063 Ludwigshafen, Germany. erzahn@aol.com
Ischinger
Thomas
T
Zeymer
Uwe
U
Brachmann
Johannes
J
Jung
Jens
J
Haase
Hartwig
H
Hauptmann
Karl Eugen
KE
Seggewiss
Hubert
H
Janicke
Ilse
I
Leschke
Matthias
M
Mudra
Harald
H
D000368:Aged; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery*; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome