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Disease Progression in the Contralateral Carotid Artery is Still Common After Endarterectomy
Carles Diaz-Duran1, Albert Clará2, Lluis Roig1
1Vascular Surgery Department, Hospital del Mar, Barcelona, Spain; Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain.
Insights
Disease progression in the contralateral carotid artery after carotid endarterectomy remains a concern. Current medical treatments have not significantly altered contralateral carotid artery disease progression rates compared to a decade ago.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Medical Imaging
Background:
- Contralateral carotid artery (CA) disease progression post-carotid endarterectomy (CEA) was historically common.
- Modern medical regimens may influence CA disease progression, necessitating updated evaluation.
- This study assesses contralateral CA disease progression over the past decade.
Purpose of the Study:
- To evaluate the rate of contralateral carotid artery disease progression following carotid endarterectomy.
- To determine if current medical management has altered historical progression rates.
Main Methods:
- Retrospective analysis of 291 patients undergoing CEA (2005-2014).
- Contralateral CA disease progression assessed via duplex ultrasound.
- Kaplan-Meier and Cox regression analyses employed.
Main Results:
- 84.5% received antiplatelet/anticoagulant agents, 77% received statins at baseline.
- Progression-free survival at 1 and 5 years was 89.3% and 68.6% for any progression.
- Progression to >70% stenosis or occlusion at 1 and 5 years was 96.8% and 90.1%.
Conclusions:
- Current contralateral CA disease progression rates post-CEA are comparable to those from over a decade ago.
- The impact of contemporary medical regimens on disease progression requires further investigation.
Background:
Disease progression in the contralateral carotid artery (CA) after a carotid endarterectomy (CEA) was common in the past. Current medication regimens for these patients are better and have probably modified this progression. We evaluated the rate of disease progression in the contralateral CA over the last decade.
Methods:
A retrospective analysis of 291 consecutive patients undergoing a CEA between 2005 and 2014 was performed. Disease progression in the contralateral CA after CEA was determined by a duplex ultrasound. Statistics were calculated by Kaplan-Meier life-tables and Cox regression.
Results:
Of the 291 patients, 246 (84.5%) received at baseline antiplatelet and/or anticoagulant agents, and 223 (77%) received statins. These proportions increased over the second half of the study. Disease progression in the contralateral CA was evaluated in 200 patients during a mean follow-up of 3.5 years. Progression-free survival rates from any disease progression at 1 and 5 years were of 89.3% and 68.6%, respectively. Free survival rates from <50% to >50% progression or from 50% to 69% to a higher category at 1 and 5 years were of 89.3% and 75.5%, respectively. Finally progression-free survival rates to a >70% stenosis or occlusion at 1 and 5 years were of 96.8% and 90.1%, respectively. Age (hazard ratio = 1.034, P = 0.048) and dyslipidemia (hazard ratio = 1.93, P = 0.045) were also associated with any disease progression.
Conclusions:
Current rates of disease progression in the contralateral CA after CEA are similar to those reported more than 1 decade ago. Further research will be needed to evaluate the impact of current medical regimens at these stages of disease.
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