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Published on: May 14, 2013
Treatment of Carotid Restenoses after Endarterectomy: A Retrospective Monocentric Study
Gautier Haupert1, Myriam Ammi1, Jeanne Hersant1
1Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France.
Insights
Endovascular procedures and open surgery show similar outcomes for carotid restenosis treatment. Endovascular methods offer shorter hospital stays and fewer hematomas, but the best endovascular strategy requires further study.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Carotid restenosis after carotid artery endarterectomy (CAE) presents a challenge in vascular surgery.
- Evaluating diverse treatment modalities is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of endovascular techniques versus iterative conventional surgery for treating carotid restenosis post-CAE.
- To assess perioperative and long-term outcomes of different treatment approaches.
Main Methods:
- Retrospective analysis of 45 carotid restenosis procedures (11 open surgery, 34 endovascular) between 2010-2017.
- Endovascular techniques included transluminal angioplasty, carotid artery stenting, and drug-coated balloon angioplasty.
- Outcomes analyzed included complication rates, hospitalization duration, survival, restenosis rates, and reinterventions using Fisher's exact test and Kaplan-Meier analysis.
Main Results:
- No significant difference in cumulated rate of morbimortality (CRMM) between open surgery (OS) and endovascular (ENDO) groups.
- ENDO group had significantly shorter hospital stays (P < 0.001) and fewer hematomas (P = 0.04) compared to OS.
- Two-year survival and survival without recurrent restenosis were comparable between OS and ENDO groups.
- No significant differences were observed among different endovascular techniques regarding CRMM, survival, or reintervention rates.
Conclusions:
- Endovascular procedures are a safe and effective alternative to iterative conventional surgery for carotid restenosis post-CAE.
- Endovascular treatment is associated with reduced hematoma formation and shorter hospitalizations.
- Further controlled studies are needed to determine the optimal endovascular strategy for this indication.
Background:
To compare the different techniques for the treatment of carotid restenosis after carotid artery endarterectomy (CAE).
Methods:
Among 1,218 carotid surgeries carried out in our center between January 2010 and November 2017, 45 procedures were performed for carotid restenosis after CAE, including 11 by iterative conventional surgery and 34 with endovascular techniques (7 transluminal angioplasties alone [TLA], 9 carotid artery stenting [CAS], and 18 angioplasties with active balloons [drug-coated balloon {DCB}]). Perioperative data (cumulated rate of morbimortality [CRMM], duration of hospitalization) and postoperative results (survival, symptomatic restenoses > 50% or asymptomatic stenoses > 70% on ultrasound, reinterventions) were collected retrospectively and analyzed with Fisher's exact test. The long-term results were estimated according to the Kaplan-Meier estimator and were compared with the log rank test (P < 0.05 was regarded as significant).
Results:
There was one secondary death due to a massive postoperative stroke in the endovascular (ENDO) group. No significant difference regarding CRMM (2.9%, P = 0.756) between the iterative conventional surgery (open surgery; OS) and the ENDO groups of was observed. Three hematomas were found in the OS group versus one in the ENDO group (P = 0.04). The length of hospital stay was shorter in the ENDO group (P < 0.001). No difference was found between the ENDO group and the OS group regarding the two-year survival or the survival without recurrent restenosis (86 vs. 100%, log rank = 0.804, and log rank = 0.114). There were 5 restenoses >70% and two reinterventions in the ENDO group (P > 0.05). The comparison of the different endovascular techniques did not show significant differences regarding the CRMM, the one-year overall survival, the survival without recurrent restenosis, or the survival without reintervention (89% in the DCB and CAS groups vs. 100% in the percutaneous transluminal angioplasty [PTA] group, log rank = 0.286; 87% in the DCB group vs. 100% in the PTA and CAS groups, log rank = 0.137; and 94% in the DCB group vs. 100% in the PTA and CAS groups, log rank = 0.585, respectively).
Conclusions:
In our experience, endovascular procedures are equivalent to iterative conventional surgery for the treatment of carotid restenoses in terms of major complications, news restenoses, or survival with less hematoma and a shorter duration of hospitalization. We however could not identify the best endovascular strategy in this indication, and a controlled study comparing the various endovascular strategies is proposed.
