Celso Ricardo Bregalda Neves1, Ivan Benaduce Casella2, Erasmo Simão da Silva2, Pedro Puech-Leão2. 1. Department of Vascular and Endovascular Surgery, University of Sao Paulo School of Medicine, Rua Haddock Lobo, 131 conj. 706, Sao Paulo, Sao Paulo 01414-001, Brazil. Electronic address: celsoneves@uol.com.br. 2. Department of Vascular and Endovascular Surgery, University of Sao Paulo School of Medicine, Rua Haddock Lobo, 131 conj. 706, Sao Paulo, Sao Paulo 01414-001, Brazil.
Abstract
PURPOSE: To report long-term results of stent placement and medical therapy for symptomatic and asymptomatic patients, respectively, with carotid artery near-occlusion with full collapse. MATERIALS AND METHODS: Between January 2008 and December 2010, 204 carotid arteries diagnosed by duplex scanning as exhibiting complete occlusion were re-examined with CT angiography; 46 arteries in 46 patients were patent with threadlike lumens and were reclassified as exhibiting near-occlusion with full collapse. Asymptomatic patients (n = 22) received best medical therapy (BMT) alone, and symptomatic patients (n = 24) were referred for carotid artery stent (CAS) placement plus BMT. Patients underwent clinical follow-up for 63.9 months ± 23.6 and duplex surveillance. RESULTS: None of the 22 asymptomatic patients treated with BMT alone experienced neurologic events during the follow-up interval. Four died of unrelated causes, resulting in a cumulative survival rate of 81.8%. Technical failure occurred in 5 of 24 symptomatic patients, but none had perioperative complications related to inability to cross the near-occlusion. Of the 19 patients with procedural success, 1 developed immediate upper limb monoparesis; none had periprocedural myocardial infarction, and none died. At 60-month follow-up, patients who underwent successful CAS placement had neurologic event-free and cumulative survival rates of 89.4% and 89.4%; patients with failed recanalization had neurologic event-free and cumulative survival rates of 0% and 40.0% (P = .01). CONCLUSIONS: Asymptomatic patients with carotid near-occlusion with full collapse experienced good outcomes with BMT alone. Symptomatic patients who underwent CAS placement demonstrated long-term survival and freedom from neurologic event rates comparable to those of asymptomatic patients.
PURPOSE: To report long-term results of stent placement and medical therapy for symptomatic and asymptomatic patients, respectively, with carotid artery near-occlusion with full collapse. MATERIALS AND METHODS: Between January 2008 and December 2010, 204 carotid arteries diagnosed by duplex scanning as exhibiting complete occlusion were re-examined with CT angiography; 46 arteries in 46 patients were patent with threadlike lumens and were reclassified as exhibiting near-occlusion with full collapse. Asymptomatic patients (n = 22) received best medical therapy (BMT) alone, and symptomatic patients (n = 24) were referred for carotid artery stent (CAS) placement plus BMT. Patients underwent clinical follow-up for 63.9 months ± 23.6 and duplex surveillance. RESULTS: None of the 22 asymptomatic patients treated with BMT alone experienced neurologic events during the follow-up interval. Four died of unrelated causes, resulting in a cumulative survival rate of 81.8%. Technical failure occurred in 5 of 24 symptomatic patients, but none had perioperative complications related to inability to cross the near-occlusion. Of the 19 patients with procedural success, 1 developed immediate upper limb monoparesis; none had periprocedural myocardial infarction, and none died. At 60-month follow-up, patients who underwent successful CAS placement had neurologic event-free and cumulative survival rates of 89.4% and 89.4%; patients with failed recanalization had neurologic event-free and cumulative survival rates of 0% and 40.0% (P = .01). CONCLUSIONS: Asymptomatic patients with carotid near-occlusion with full collapse experienced good outcomes with BMT alone. Symptomatic patients who underwent CAS placement demonstrated long-term survival and freedom from neurologic event rates comparable to those of asymptomatic patients.
Authors: A Garcia-Pastor; A Gil-Núñez; J M Ramirez-Moreno; N González-Nafría; J Tejada; F Moniche; J C Portilla-Cuenca; P Martínez-Sánchez; B Fuentes; M A Gamero-García; M A de Leciñana; J Masjuan; D C Verge; Y Aladro; V Parkhutik; A Lago; A M de Arce-Borda; M Usero-Ruiz; R Delgado-Mederos; A Pampliega; Á Ximenez-Carrillo; M Bártulos-Iglesias; E Castro-Reyes Journal: AJNR Am J Neuroradiol Date: 2022-08-18 Impact factor: 4.966