Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study
Por:
Garcia-Pastor, A, Gil-Nunez, A, Ramirez-Moreno, JM, Gonzalez-Nafria, N, Tejada, J, Moniche, F, Portilla-Cuenca, JC, Martinez-Sanchez, P, Fuentes, B, Gamero-Garcia, MA, de Lecinana, MA, Masjuan, J, Verge, DC, Aladro, Y, Parkhutik, V, Lago, A, De Arce-Borda, AM, Usero-Ruiz, M, Delgado-Mederos, R, Pampliega, A, Ximenez-Carrillo, A, Bartulos-Iglesias, M, Castro-Reyes, E
Publicada:
1 sep 2022
Ahead of Print:
1 ago 2022
Resumen:
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.
Filiaciones:
Garcia-Pastor, A:
Hosp Gen Univ Gregorio Maranon, Dept Neurol, Madrid, Spain
Gil-Nunez, A:
Hosp Gen Univ Gregorio Maranon, Dept Neurol, Madrid, Spain
Ramirez-Moreno, JM:
Hosp Univ Infanta Cristina, Dept Neurol, Badajoz, Spain
Gonzalez-Nafria, N:
Complejo Asistencial Univ Leon, Dept Neurol, Neurol, Leon, Spain
Tejada, J:
Complejo Asistencial Univ Leon, Dept Neurol, Neurol, Leon, Spain
Moniche, F:
Hosp Univ Virgen Rocio, Dept Neurol, Seville, Spain
Portilla-Cuenca, JC:
Hosp San Pedro Alcantara, Dept Neurol, Caceres, Spain
Martinez-Sanchez, P:
Hosp Univ La Paz, Dept Neurol, Madrid, Spain
Fuentes, B:
Hosp Univ La Paz, Dept Neurol, Madrid, Spain
Gamero-Garcia, MA:
Hosp Univ Virgen Macarena, Dept Neurol, Seville, Spain
de Lecinana, MA:
Hosp Univ Ramon y Cajal, Dept Neurol, Madrid, Spain
Masjuan, J:
Hosp Univ Ramon y Cajal, Dept Neurol, Madrid, Spain
Verge, DC:
Corporacio Sanitaria Parc Tauli, Dept Neurol, Sabadell, Spain
Aladro, Y:
Hosp Univ Getafe, Dept Neurol, Getafe, Spain
Parkhutik, V:
Hosp Univ La Fe, Dept Neurol, Valencia, Spain
Lago, A:
Hosp Univ La Fe, Dept Neurol, Valencia, Spain
De Arce-Borda, AM:
Hosp Univ Donostia, Dept Neurol, Donostia San Sebastian, Spain
Usero-Ruiz, M:
Hosp Univ Valladolid, Dept Neurol, Valladolid, Spain
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Pampliega, A:
Hosp Gen Univ Alicante, Dept Neurol, Alicante, Spain
Ximenez-Carrillo, A:
Hosp Univ La Princesa, Dept Neurol Ax C, Madrid, Spain
Bartulos-Iglesias, M:
Hosp Univ Burgos, Dept Neurol, Burgos, Spain
Castro-Reyes, E:
Hosp Gen Univ Gregorio Maranon, Dept Neurol, Madrid, Spain
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