Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis.
BACKGROUND
Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis.


METHODS
We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death).


RESULTS
A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6-171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis.


CONCLUSIONS
We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
Marine
http://orcid.org/0000-0001-9717-475X
M
Gaudry
APHM, Hôpital Timone, Department of Radiology, 13005, Marseille, France.
Jean-Michel
JM
Bartoli
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
Laurence
L
Bal
Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.|APHM, Hôpital Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France.
Roch
R
Giorgi
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
Mariangela
M
De Masi
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
Pierre-Edouard
PE
Magnan
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
Philippe
P
Piquet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000033:anatomy & histology / Q000601:surgery; D017536:Carotid Artery, Common / Q000033:anatomy & histology / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000209:etiology*; D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000209:etiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome