title: Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  Do asymptomatic restenoses > 70% after carotid endarterectomy (CEA) and carotid stenting (CAS) increase the risk of late ipsilateral stroke?
  
  
  METHODS
  Systematic review identified 11 randomised controlled trials (RCTs) reporting rates of restenosis > 70% (and/or occlusion) in patients who had undergone CEA/CAS for the treatment of primary atherosclerotic disease, and nine RCTs reported late ipsilateral stroke rates. Proportional meta-analyses and odds ratios (OR) at end of follow-up were performed.
  
  
  RESULTS
  The weighted incidence of restenosis > 70% was 5.8% after "any" CEA, median 47 months (11 RCTs; 4249 patients); 4.1% after patched CEA, median 32 months (5 RCTs; 1078 patients), and 10% after CAS, median 62 months (5 RCTs; 2716 patients). In four RCTs (1964 patients), one of 125 (0.8%) with restenosis > 70% (or occlusion) after CAS suffered late ipsilateral stroke over a median 50 months, compared with 37 of 1839 (2.0%) in CAS patients with no significant restenosis (OR 0.87; 95% CI 0.24-3.21; p = .8339). In seven RCTs (2810 patients), 13 out of 141 (9.2%) with restenosis > 70% (or occlusion) after CEA suffered late ipsilateral stroke over a median 37 months, compared with 33 out of 2669 (1.2%) in patients with no significant restenoses (OR 9.02; 95% CI 4.70-17.28; p < .0001). Following data correction to exclude patients whose surveillance scan showed no evidence of restenosis > 70% before stroke onset, the prevalence of stroke ipsilateral to an untreated asymptomatic > 70% restenosis was seven out of 135 (5.2%) versus 40 out of 2704 (1.5%) in CEA patients with no significant restenosis (OR 4.77; 95% CI 2.29-9.92).
  
  
  CONCLUSIONS
  CAS patients with untreated asymptomatic > 70% restenosis had an extremely low rate of late ipsilateral stroke (0.8% over 50 months). CEA patients with untreated, asymptomatic > 70% restenosis had a significantly higher risk of late ipsilateral stroke (compared with patients with no restenosis), but this was only 5% at 37 months. Overall, 97% of all late ipsilateral strokes after CAS and 85% after CEA occurred in patients without evidence of significant restenosis or occlusion.
authors.affiliation: Department of Vascular Surgery at Leicester Royal Infirmary, Leicester, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Vascular Surgery at Leicester Royal Infirmary, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Batchelder
authors.affiliation: Department of Vascular Surgery at Leicester Royal Infirmary, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Saratzis
authors.affiliation: Division of Vascular Surgery, West Virginia University, Charleston, VA, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: AbuRahma
authors.affiliation: Neurologische Klinik der Ruprecht-Karls-Universität, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Ringleb
authors.affiliation: Division of Vascular Surgery, University of Maryland, Baltimore, MD, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Lal
authors.affiliation: Hospital Sainte-Anne, Université Paris-Descartes, Paris, France.
authors.forename: J L
authors.initials: JL
authors.lastname: Mas
authors.affiliation: Department of Vascular and Endovascular Surgery, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Steinbauer
authors.affiliation: Department of Vascular Surgery at Leicester Royal Infirmary, Leicester, UK. Electronic address: ross.naylor@uhl-tr.nhs.uk.
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Carotid endarterectomy; Carotid stenting; Recurrent stroke; Restenosis