Abstract 3836: Favorable Outcomes for Carotid Stenting in Patients with Restenosis after Carotid Endarterectomy
Background: Repeat carotid endarterectomy (CEA) for carotid restenosis carries a higher complication rate than the index procedure. We sought to determine outcomes for carotid stenting after CEA restenosis.
Methods: We evaluated 30-day outcomes of 552 patients at our institution who underwent de novo carotid stenting with embolic protection between Aug 1999 and Aug 2005, according to whether or not they had CEA restenosis. We also performed multivariate analysis to address for differences in baseline characteristics.
Results: The cohort contained 123 patients with restenosis after CEA. Patients with history of CEA restenosis did not differ in age (mean age 71), history of transient ischemic attack or stroke. Patients with history of CEA restenosis were less likely to have diabetes (32% vs. 42%, p=0.048), history of coronary artery disease (69% vs. 81%, p=0.003), and history of neck radiation (1.6% vs. 7.1%, P=0.02). These patients were more likely to have hypertension (94% vs. 88%, p=0.04) and peripheral vascular disease (59% vs. 37%, p<0.0001). The 30-day incidence of death, myocardial infarction, or stroke was 1.6% for patients with history of CEA restenosis compared to 5.1% for those without (p=0.13). On multivariate analysis, patients undergoing stenting for restenosis after CEA had a trend for decreased overall risk (OR=0.33. p=0.14 95% CI=.08–1.45). At a mean follow-up of 842 days, 1.1% of entire cohort underwent target vessel revascularization (2.4% for patients with CEA restenosis vs. 0.7% for patients without CEA restenosis, P=0.34).
Conclusion: Patients with history of restenosis after carotid endarterec-tomy have a favorable outcome after carotid stenting, including a low rate of target vessel revascularization. Carotid stenting provides a safe and effective strategy for revascularization in patients with history of restenosis after carotid endarterectomy.