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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Restenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study
Caroline Arquizan1, Ludovic Trinquart, Pierre-Jean Touboul
1Service de Neurologie, Hôpital Gui de Chauliac, Université Montpellier, INSERM UMR894, Montpellier, France.
Insights
Carotid angioplasty and stenting (CAS) showed a higher rate of moderate restenosis compared to carotid endarterectomy (CEA). Longer follow-up is needed to assess severe restenosis and stroke risk.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Cerebrovascular Disease
Background:
- Carotid angioplasty and stenting (CAS) and carotid endarterectomy (CEA) are procedures to treat carotid artery stenosis.
- Concerns exist regarding higher rates of restenosis after CAS compared to CEA.
Purpose of the Study:
- To compare the rates of restenosis between CAS and CEA in patients undergoing treatment for carotid artery stenosis.
- To evaluate the incidence of residual or recurrent stenosis following CAS versus CEA.
Main Methods:
- A total of 507 patients were analyzed, with 242 treated with CAS and 265 with CEA.
- Carotid ultrasound follow-up was conducted for a mean of 2.1 years.
- Restenosis was defined as 50-69% or ≥70% stenosis, with occlusion also assessed.
Main Results:
- The rate of restenosis (≥50% or occlusion) was significantly higher after CAS (12.5%) than after CEA (5.0%).
- Severe restenosis (≥70% or occlusion) rates were low and similar between groups at 3 years.
- Age was the only vascular risk factor associated with restenosis; no effect on ipsilateral stroke was detected.
Conclusions:
- The short-term incidence of moderate restenosis (≥50%) is approximately 2.5 times higher after CAS than CEA.
- Further long-term studies are required to evaluate late severe restenosis and its association with recurrent stroke.
Background And Purpose:
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.
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