Abstract 14423: Outcomes of Carotid Artery Stenting for Recurrent Carotid Artery Restenosis Following Prior Ipsilateral Carotid Artery Endarterectomy or Stenting
Background: Restenosis occurs in 5-15% of patients who undergo carotid artery endarterectomy (CEA) or stenting (CAS). Recurrent stenosis can be treated with CAS; however, outcomes of this approach - specifically for patients with “in-stent” restenosis - have not been reported broadly. We present the largest series to date of patients undergoing CAS for restenosis.
Methods and Results: The records of patients enrolled in the National Cardiovascular Database Registry-Carotid Artery Revascularization and Endarterectomy (NCDR-CARE) Registry were examined. We analyzed and compared patient and procedural characteristics and clinical outcomes of three cohorts of patients undergoing stenting: Group A-CAS for de novo carotid artery stenosis (CAS-DN; n=7745); Group B -CAS after prior CEA (CAS-p-CEA; n=1349); and Group C: CAS for in-stent restenosis after prior CAS (CAS-p-CAS; n=205).
Results: The unadjusted primary end point, a composite of in-hospital death, stroke, and/or myocardial infarction, occurred less frequently in the combined restenotic cohorts (CAS-p-CEA plus CAS-p-CAS; n=1554) compared to CAS-DN patients (2.64% vs. 4.57%, p<0.001). This was due to fewer neurological adverse events (new stroke or transient ischemic attack) (2.00% vs. 4.04%, p<0.001). After propensity score adjustment, a lower rate of the primary composite endpoint persisted (odds ratio 0.57; 95% confidence interval, 0.41-0.80; p=0.0012). Furthermore, within the restenotic patients, Group C (CAS-p-CAS) demonstrated a lower rate of the composite end point compared to Group B (CAS-p-CEA), 0.49% vs. 2.97%, p=0.039.
Conclusion: This represents the largest reported dataset of CAS following prior carotid artery revascularization. CAS for restenosis after prior revascularization is associated with low periprocedural adverse event rates. Outcomes in CAS for restenosis are superior to those in CAS for de novo carotid artery stenosis. Furthermore, the exceptionally low periprocedural adverse event rates (0.49%) in patients undergoing repeat CAS indicate that this approach is safe for in-stent restenosis.
- © 2011 by American Heart Association, Inc.