Patch, interposition graft or stent for treatment of restenosis after carotid endarterectomy: a retrospective study

• Published in: European surgery Vol. 47; no. 4; pp. 157 - 165
• Main Authors: Aspalter, M., Linni, K., Ugurluoglu, A., Hitzl, W., Hölzenbein, T.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.08.2015
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Surgery; Vascular Surgery; Post-CEA restenosis; Carotid interposition graft; Carotid artery stenting; Redo CEA
• ISSN: 1682-8631; 1682-4016
• DOI: 10.1007/s10353-015-0323-y

Summary Background Uncertainty surrounding the indication for treatment of post carotid-endarterectomy restenosis (pCEAR) exists. Conventional patch angioplasty (rCEA), carotid interposition graft (CIG), and stent-assisted angioplasty (CAS) have been studied; comparisons of these techniques have not been performed. Methods A time to event analysis of consecutive patients undergoing treatment for pCEAR was performed. Primary end-point was any cerebrovascular or myocardial event or death. Long-term results were expressed in Kaplan–Meier estimates. Results From 02/1997 to 03/2013, 93 procedures for severe pCEAR were performed in 89 consecutive patients. Group 1 consisted of 37 rCEA (40 %), group 2 included 33 CIG (35 %), and group 3 contained 23 CAS (25 %). Median time from primary CEA was significantly longer in group 2 compared with group 3 (118 vs. 54 months; p  = 0.02). Groups were comparable with regard to degree of stenosis and cardiovascular risk factors. Five patients (6 %) underwent initial angiography with intention of CAS, but the procedures could not be completed (insufficient access n  = 3, neurological symptoms n  = 2) and open surgery was performed (rCEA: n  = 4; CIG: n  = 1). One perioperative death related to major stroke occurred in group 3 (3.6 %). There were no differences in 4-year estimated survival and event-free survival, whereas patients in group 3 were more likely to undergo a tertiary intervention (13 % at 4 years 95 % CI: 11–45 % p  = 0.014). Conclusions All three groups presented with similar long-term outcome with regard to the predefined endpoints. Although associated with less perioperative complications, CAS required significantly more tertiary interventions. Carotid interposition graft was not superior to redo patch plasty.