A Garcia-Pastor1, A Gil-Núñez2, J M Ramirez-Moreno3, N González-Nafría4, J Tejada4, F Moniche5, J C Portilla-Cuenca6, P Martínez-Sánchez7, B Fuentes7, M A Gamero-García8, M A de Leciñana9, J Masjuan9, D C Verge10, Y Aladro11, V Parkhutik12, A Lago12, A M de Arce-Borda13, M Usero-Ruiz14, R Delgado-Mederos15, A Pampliega16, Á Ximenez-Carrillo17, M Bártulos-Iglesias18, E Castro-Reyes2. 1. From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain angarpas@yahoo.es. 2. From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain. 3. Department of Neurology (J.M.R.-M.), Hospital Universitario Infanta Cristina, Badajoz, Spain. 4. Department of Neurology (N.G.-N., J.T.), Complejo Asistencial Universitario de León, Neurology, Leon, Spain. 5. Department of Neurology (F.M.), Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, Spain. 6. Department of Neurology (J.C.P.-C.), Hospital San Pedro Alcántara, Cáceres, Spain. 7. Department of Neurology (P.M.-S., B.F.), Hospital Universitario La Paz, Madrid, Spain. 8. Department of Neurology (M.A.G.-G.), Hospital Universitario Virgen Macarena, Sevilla, Spain. 9. Department of Neurolog (M.A.d.L., J.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain. 10. Department of Neurology (D.C.V.), Corporació Sanitaria Parc Taulí, Sabadell, Spain. 11. Department of Neurology (Y.A.), Hospital Universitario de Getafe, Getafe, Spain. 12. Department of Neurology (V.P., A.L.), Hospital Universitari La Fe, Valencia, Spain. 13. Department of Neurology (A.M.d.A.-B), Hospital Universitario de Donostia, Donostia, Spain. 14. Department of Neurology (M.U.-R.), Hospital Universitario de Valladolid, Valladolid, Spain. 15. Department of Neurology (R.D.-M.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 16. Department of Neurology (A.P.), Hospital General Univeristario de Alicante, Alicante, Spain. 17. Department of Neurology (Á.X.-C.), Hospital Universitario de La Princesa, Madrid, Spain. 18. Department of Neurology (M.B.-I.), Hospital Universitario de Burgos, Burgos, Spain.
Abstract
BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.
BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.
Authors: Allan J Fox; Michael Eliasziw; Peter M Rothwell; Matthias H Schmidt; Charles P Warlow; Henry J M Barnett Journal: AJNR Am J Neuroradiol Date: 2005-09 Impact factor: 3.825
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Authors: A García-Pastor; A Gil-Núñez; J M Ramírez-Moreno; N González-Nafría; J Tejada; F Moniche; J C Portilla-Cuenca; P Martínez-Sánchez; B Fuentes; M Á Gamero-García; M Alonso de Leciñana; J Masjuán; D Cánovas-Verge; Y Aladro; V Parkhutik; A Lago-Martín; A M de Arce-Borda; M Usero-Ruíz; R Delgado-Mederos; A Pampliega; Á Ximenez-Carrillo; M Bártulos-Iglesias; E Castro-Reyes Journal: Eur J Neurol Date: 2019-06-17 Impact factor: 6.089
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Authors: P M Rothwell; M Eliasziw; S A Gutnikov; A J Fox; D W Taylor; M R Mayberg; C P Warlow; H J M Barnett Journal: Lancet Date: 2003-01-11 Impact factor: 79.321