title: Carotid angioplasty and stenting is safe and effective for treatment of recurrent stenosis after eversion endarterectomy.
abstract: OBJECTIVE
  This study was conducted to determine the efficiency and long-term durability of percutaneous transluminal angioplasty and carotid artery stenting in carotid restenosis (CR) treatment after eversion endarterectomy, with emphasis on variables that could influence the outcome.
  
  
  METHODS
  We analyzed 319 patients (220 asymptomatic and 99 symptomatic) who underwent carotid angioplasty from 2002 until 2012 for CR that occurred after eversion endarterectomy. During this period, 7993 eversion endarterectomies were done for significant carotid artery stenosis. Significant CR was detected by ultrasound examination and confirmed by digital subtraction angiography or multidetector computed tomography angiography. After angioplasty (with or without stenting), color duplex ultrasound imaging was done after 1 month, 6 months, 1 year, and annually thereafter. End points encompassed myocardial infarction, stroke, and cardiovascular death (fatal myocardial infarction, fatal cardiac failure, fatal stroke), and also puncture site hematoma and recurrent restenosis. Primary end points were analyzed as early results (≤30 days after the procedure), and secondary end points were long-term results (>30 days). Variables and risk factors influencing the early-term and long-term results were also analyzed. Median follow-up was 49.8 ± 22.8 months (range, 17-121 months).
  
  
  RESULTS
  All but one procedure ended with a technical success (99.7%). In the early postoperative period, transient ischemic attack occurred in 2.8% of the patients and stroke in 1.6%, followed by one lethal outcome (0.3%). Stent thrombosis occurred in one patient (0.3%) several hours after the angioplasty, followed by urgent surgery and graft interposition. In the long-term follow-up, there were no transient ischemic attacks or strokes, non-neurologic mortality was 3.13%, and the recurrent restenosis rate was 4.4%. The rate of non-neurologic outcomes during the follow-up was significantly higher in asymptomatic patients than in symptomatic patients (4.54% vs 0%; P = .034). The statically highest rate of transient ischemic attack was verified in patients in whom Precise (Cordis Corporation, New Brunswick, NJ) stents was used (12.2%) and a Spider Fx (Covidien, Dublin, Ireland) cerebral protection device (12.5%) was used. Female gender, coronary artery disease, plaque calcifications, and smoking history were associated with an adverse outcome after angioplasty.
  
  
  CONCLUSIONS
  Carotid artery stenting is safe and reliable procedure for CR after eversion endarterectomy treatment, with low rate of postprocedural complications. Type of stent and cerebral embolic protection device may influence the rate of postprocedural neurologic ischemic events.
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Djordje
authors.initials: D
authors.lastname: Radak
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia. Electronic address: drslobex@yahoo.com.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Tanaskovic
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Department for Diagnostic and Interventional Radiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Dragan
authors.initials: D
authors.lastname: Sagic
authors.affiliation: Department for Diagnostic and Interventional Radiology, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Zelimir
authors.initials: Z
authors.lastname: Antonic
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Babic
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Petar
authors.initials: P
authors.lastname: Popov
authors.affiliation: Vascular Surgery Clinic, "Dedinje" Cardiovascular Institute, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Matic
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Rancic
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex