Carotid artery stenting (CAS) has been proposed as the treatment of choice in case of post-carotid endarterectomy (CEA) restenosis. The aim of the study is to analyze periprocedural results of CAS for the treatment of post-CEA restenosis (RES) compared with those of CAS performed for primary carotid stenosis (PRS).
Data from consecutive patients submitted to CAS at our Institution from 2008 to 2016 were retrospectively reviewed. Patients with in-stent restenosis were excluded. Initially, preoperative risk factors, demographics, intraoperative variables and perioperative outcome were analyzed according to indication group (PRS and RES). Then, propensity score matching was performed obtaining two homogeneous groups of patients. Covariates included were: age, gender, hypertension, hyperlipidemia, cardiac disease, chronic renal disease, symptomatic carotid plaque and positive ipsilateral brain CT-scan. Intraoperative data and perioperative outcomes were then compared between the two matched groups.
Of 480 included patients, 300 (62.5%) underwent CAS for PRS, and 180 (37.5%) for RES. After propensity score analysis (158 patients per group), no significant difference were observed in terms of technical success, number and type of stent used, except for need of intraoperative atropine administration that was higher in PRS group (38.6% vs 13.3%, respectively; p<.001). In the perioperative period, the composite neurological event was significantly higher in PRS group (7.6% vs 1.9%; p=.017). Moreover, need of ionotropic support was higher in PRS group (8.9% vs 1,9%; p=.0069). Myocardial infarction rate and 30-day mortality were similar in the two groups (p=.317; p=1, respectively).
In a large single-center experience, CAS for post-CEA restenosis was associated with a significantly lower risk of any neurological event and of hemodynamic instability in the perioperative period as compared to CAS performed for primary carotid lesions. Our results confirm that post-CEA restenosis may represent an elective indication for CAS.
Copyright © 2020. Published by Elsevier Inc.