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Updated: Feb 21, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Outcomes of Primary and Secondary Carotid Artery Stenting
Isibor J Arhuidese1, Muhammad Rizwan1, Besma Nejim1
1From the Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, MD (I.J.A., M.R., B.N., M.M.); and Division of Vascular Surgery, University of South Florida, Tampa (I.J.A.).
Insights
Carotid angioplasty and stenting after prior endarterectomy (CASAPICEA) showed lower stroke/death risk in symptomatic patients compared to primary-CAS. Both CASAPICEA and redo-CAS reduced hypotension and bradycardia risks versus primary-CAS.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Secondary carotid angioplasty and stenting (CAS) outcomes are not well-understood.
- This study compares redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) to primary-CAS.
Purpose of the Study:
- To evaluate the risks and outcomes of secondary CAS procedures.
- To compare CASAPICEA and redo-CAS with primary-CAS in terms of stroke, death, and other complications.
Main Methods:
- Analysis of 11,742 CAS procedures (primary-CAS, CASAPICEA, redo-CAS) from 2003-2016 in the Vascular Quality Initiative.
- Kaplan-Meier, logistic, and Cox regression analyses were used to assess 30-day and 1-year outcomes.
- Predictors of outcomes were identified.
Main Results:
- CASAPICEA was associated with significantly lower 30-day stroke/death compared to primary-CAS in symptomatic patients (OR 0.60).
- Both CASAPICEA and redo-CAS showed significantly lower odds of hypotension and bradycardia compared to primary-CAS.
- No significant differences in 1-year stroke/death hazards were observed between secondary CAS groups and primary-CAS.
Conclusions:
- CASAPICEA offers a significantly lower risk of periprocedural stroke/death in symptomatic patients compared to primary-CAS.
- CASAPICEA and redo-CAS are associated with reduced odds of hypotension and bradycardia but increased odds of hypertension versus primary-CAS.
Background And Purpose:
Little is known of the excess risk attributable to secondary carotid angioplasty and stenting (CAS). This study evaluates outcomes of redo-CAS and CAS after prior ipsilateral carotid endarterectomy (CASAPICEA) relative to primary-CAS.
Methods:
We studied all patients in the Vascular Quality Initiative, who underwent primary-CAS, CASAPICEA, or redo-CAS (2003-2016). Kaplan-Meier, multivariable logistic and Cox regression analyses were used to evaluate outcomes within 30 days and up to 1 year and identify their predictors.
Results:
There were 11 742 CAS procedures performed: 8519 (72%) primary-, 2645 (23%) CASAPICEA, and 578 (5%) redo-CAS. Comparing primary-CAS versus CASAPICEA versus redo-CAS, 30-day stroke/death was 2.5% versus 2.0% versus 1.3% for asymptomatic patients (P=0.23) and 5.2% versus 2.6% versus 5.0% for symptomatic patients (P=0.003). CASAPICEA was associated with significantly lower 30-day stroke/death (odds ratio: 0.60; 95% confidence interval: 0.37-0.98; P=0.04) compared with primary-CAS among symptomatic patients. The odds of bradycardia were lower following CASAPICEA (odds ratio: 0.32; 95% confidence interval: 0.26-0.39; P<0.001) and redo-CAS (odds ratio: 0.55; 95% confidence interval: 0.39-0.78; P=0.001) compared with primary-CAS. Similarly, the odds of hypotension were significantly lower in both groups compared with primary-CAS (CASAPICEA: 0.41 [0.35-0.48], P<0.001; redo-CAS: 0.66 [0.50-0.86] P=0.003). There were no significant differences in the hazards of stroke/death at 1 year for CASAPICEA and redo-CAS compared with primary-CAS.
Conclusions:
CASAPICEA is associated with significantly lower odds of periprocedural stroke/death compared with primary-CAS among symptomatic patients. CASAPICEA and redo-CAS are associated with significantly lower odds of periprocedural hypotension and bradycardia but higher odds of hypertension compared with primary-CAS.
