Disease Progression in the Contralateral Carotid Artery is Still Common After Endarterectomy

• Published in: Annals of vascular surgery Vol. 50; pp. 225 - 230
• Main Authors: Diaz-Duran, Carles, Clará, Albert, Roig, Lluis, Ruiz-Carmona, Carlos, Mellado Joan, Meritxell, Elosua, Roberto
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2018
• Subjects: Aged; Anticoagulants - therapeutic use; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - mortality; Carotid Artery Diseases - surgery; Disease Progression; Disease-Free Survival; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - mortality; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Predictive Value of Tests; Proportional Hazards Models; Retrospective Studies; Spain; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2017.11.068

Disease progression in the contralateral carotid artery (CA) after a carotid endarterectomy (CEA) was common in the past. Current medication regimens for these patients are better and have probably modified this progression. We evaluated the rate of disease progression in the contralateral CA over the last decade. A retrospective analysis of 291 consecutive patients undergoing a CEA between 2005 and 2014 was performed. Disease progression in the contralateral CA after CEA was determined by a duplex ultrasound. Statistics were calculated by Kaplan-Meier life-tables and Cox regression. Of the 291 patients, 246 (84.5%) received at baseline antiplatelet and/or anticoagulant agents, and 223 (77%) received statins. These proportions increased over the second half of the study. Disease progression in the contralateral CA was evaluated in 200 patients during a mean follow-up of 3.5 years. Progression-free survival rates from any disease progression at 1 and 5 years were of 89.3% and 68.6%, respectively. Free survival rates from <50% to >50% progression or from 50% to 69% to a higher category at 1 and 5 years were of 89.3% and 75.5%, respectively. Finally progression-free survival rates to a >70% stenosis or occlusion at 1 and 5 years were of 96.8% and 90.1%, respectively. Age (hazard ratio = 1.034, P = 0.048) and dyslipidemia (hazard ratio = 1.93, P = 0.045) were also associated with any disease progression. Current rates of disease progression in the contralateral CA after CEA are similar to those reported more than 1 decade ago. Further research will be needed to evaluate the impact of current medical regimens at these stages of disease.