title: Restenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study.
abstract: OBJECTIVE
  Carotid angioplasty and stenting (CAS) may be more often associated with residual or recurrent stenosis than carotid endarterectomy (CEA). We compared the rates of restenosis in patients treated with CAS or CEA in the EVA-3S trial.
  
  
  METHODS
  Five hundred seven patients (242 treated by CAS and 265 by CEA) had carotid ultrasound follow-up (mean carotid ultrasound follow-up, 2.1 years) according to a predefined protocol. Carotid restenosis of 50% to 69% was diagnosed on planimetry, whereas carotid restenosis of ≥70% or occlusion was diagnosed using either planimetry or velocity criteria.
  
  
  RESULTS
  The rate of carotid restenosis of ≥50% or occlusion was significantly higher after CAS (12.5%) than after CEA (5.0%; time ratio, 0.16; 95% CI, 0.03-0.76; P=0.02). The rates of severe restenosis of ≥70% or occlusion were low and did not differ significantly between the 2 groups (3-year rates are 3.3% in the CAS group and 2.8% in the CEA group). Age at baseline was the only vascular risk factor significantly associated with carotid restenosis. Our study could not detect any effect of carotid restenosis on ipsilateral stroke.
  
  
  CONCLUSIONS
  The short-term rate of carotid restenosis of ≥50% or occlusion is ≈2.5-times more common after CAS than after CEA, a difference accounted for by an excess risk in moderate restenosis. More data with longer follow-up are needed to assess the rates of late severe restenosis and to determine the relation between restenosis and recurrent stroke over time.
authors.affiliation: Service de Neurologie, Hôpital Gui de Chauliac, Université Montpellier, INSERM UMR894, Montpellier, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Arquizan
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Anne
authors.initials: A
authors.lastname: Long
authors.forename: Séverine
authors.initials: S
authors.lastname: Feasson
authors.forename: Béatrice
authors.initials: B
authors.lastname: Terriat
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Gobin-Metteil
authors.forename: Brigitte
authors.initials: B
authors.lastname: Guidolin
authors.forename: Serge
authors.initials: S
authors.lastname: Cohen
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods / Q000639:trends*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods / Q000639:trends; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000639:trends; D012307:Risk Factors; D055502:Secondary Prevention; D016037:Single-Blind Method; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography