Kumar, R. and Batchelder, A. and Saratzis, A. and AbuRahma, A. F. and Ringleb, P. and Lal, B. K. and Mas, J. L. and Steinbauer, M. and Naylor, A. R. (2017) Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis. EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 53 (6). pp. 766-775. ISSN 1078-5884, 1532-2165
Full text not available from this repository. (Request a copy)Abstract
Objective: Do asymptomatic restenoses > 70% after carotid endarterectomy (CEA) and carotid stenting (CAS) increase the risk of late ipsilateral stroke? Methods: Systematic review identified 11 randomised controlled trials (RCTs) reporting rates of restenosis > 70% (and/or occlusion) in patients who had undergone CEA/CAS for the treatment of primary atherosclerotic disease, and nine RCTs reported late ipsilateral stroke rates. Proportional meta-analyses and odds ratios (OR) at end of follow-up were performed. Results: The weighted incidence of restenosis > 70% was 5.8% after "any" CEA, median 47 months (11 RCTs; 4249 patients); 4.1% after patched CEA, median 32 months (5 RCTs; 1078 patients), and 10% after CAS, median 62 months (5 RCTs; 2716 patients). In four RCTs (1964 patients), one of 125 (0.8%) with restenosis > 70% (or occlusion) after CAS suffered late ipsilateral stroke over a median 50 months, compared with 37 of 1839 (2.0%) in CAS patients with no significant restenosis (OR 0.87; 95% CI 0.24-3.21; p = .8339). In seven RCTs (2810 patients), 13 out of 141 (9.2%) with restenosis > 70% (or occlusion) after CEA suffered late ipsilateral stroke over a median 37 months, compared with 33 out of 2669 (1.2%) in patients with no significant restenoses (OR 9.02; 95% CI 4.70-17.28; p <.0001). Following data correction to exclude patients whose surveillance scan showed no evidence of restenosis > 70% before stroke onset, the prevalence of stroke ipsilateral to an untreated asymptomatic > 70% restenosis was seven out of 135 (5.2%) versus 40 out of 2704 (1.5%) in CEA patients with no significant restenosis (OR 4.77; 95% CI 2.29-9.92). Conclusions: CAS patients with untreated asymptomatic > 70% restenosis had an extremely low rate of late ipsilateral stroke (0.8% over 50 months). CEA patients with untreated, asymptomatic > 70% restenosis had a significantly higher risk of late ipsilateral stroke (compared with patients with no restenosis), but this was only 5% at 37 months. Overall, 97% of all late ipsilateral strokes after CAS and 85% after CEA occurred in patierits without evidence of significant restenosis or occlusion. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PROSPECTIVE RANDOMIZED-TRIAL; TERM-FOLLOW-UP; VELOCITY CRITERIA; ARTERY-DISEASE; ENDARTERECTOMY; STENOSIS; ANGIOPLASTY; MANAGEMENT; ACUSEAL; CLOSURE; Carotid endarterectomy; Carotid stenting; Restenosis; Recurrent stroke |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Abteilung für Gefäßchirurgie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 14 Dec 2018 13:10 |
| Last Modified: | 01 Oct 2020 07:26 |
| URI: | https://pred.uni-regensburg.de/id/eprint/763 |
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