Comparison of Carotid Endarterectomy and Stenting for Symptomatic Internal Carotid Artery Near-Occlusion
J. Kim, S. Male, D. Damania, B.S. Jahromi and R.P. Tummala
American Journal of Neuroradiology June 2019, DOI: https://doi.org/10.3174/ajnr.A6085
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Abstract
BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion.
MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow-up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis.
RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20% restenosis and 79% vessel maturation rates, while patients with carotid endarterectomy had 17.4% restenosis and 84% vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures.
CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.
ABBREVIATIONS:
CAS
carotid artery stenting
CCA
common carotid artery
CEA
carotid endarterectomy
ECST
European carotid surgery trial
PSV
peak systolic velocity
Footnotes
Disclosures: Ramachandra P. Tummala—UNRELATED: Grants/Grants Pending: MicroVention, Comments: unrestricted fellowship education grant, not used for the submitted work.* *Money paid to the institution.
© 2019 by American Journal of Neuroradiology
J. Kim, S. Male, D. Damania, B.S. Jahromi and R.P. Tummala
American Journal of Neuroradiology June 2019, DOI: https://doi.org/10.3174/ajnr.A6085
ArticleFigures & DataInfo & MetricsReferences PDF
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion.
MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow-up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis.
RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20% restenosis and 79% vessel maturation rates, while patients with carotid endarterectomy had 17.4% restenosis and 84% vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures.
CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.
ABBREVIATIONS:
CAS
carotid artery stenting
CCA
common carotid artery
CEA
carotid endarterectomy
ECST
European carotid surgery trial
PSV
peak systolic velocity
Footnotes
Disclosures: Ramachandra P. Tummala—UNRELATED: Grants/Grants Pending: MicroVention, Comments: unrestricted fellowship education grant, not used for the submitted work.* *Money paid to the institution.
© 2019 by American Journal of Neuroradiology
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