SYMPTOMATIC MODERATE CAROTID STENOSIS (50–69%) — RETROSPECTIVE ANALYSIS

Authors

  • Pedro Pinto Sousa Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Vila Nova de Gaia/espinho, Portugal
  • Gabriela Lopes Serviço de Neurologia; Centro Hospitalar Universitário do Porto, Portugal
  • Gabriela Teixeira Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário do Porto, Portugal
  • Rui Almeida Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário do Porto, Portugal
  • Pedro Sá Pinto Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Universitário do Porto, Portugal

DOI:

https://doi.org/10.48750/acv.155

Keywords:

Carotid artery stenosis, Carotid artery stenting, Carotid endarterectomy, Best medical treatment, Symptomatic carotid stenosis, Moderate carotid stenosis

Abstract

Introduction: The European Society for Vascular Surgery (ESVS), following the most validated data published by North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ECST) and Symptomatic Veterans Affairs Co-operative Study Trial (SVACS), determina, regarding symptomatic carotid endarterectomy, designated carotid endarterectomy (CEA) to be considered for patients reporting carotid territory symptoms within the preceding 6 months and diagnosed with moderate (50–69%) carotid stenosis (MCS)(1).

Aims: Analyse the admitted patients with MCS, scrutinise the therapeutic orientation and evaluate its adequacy.

Materials and methods: The authors retrospectively studied all consecutive patients admitted at one single Institution with symptomatic MCS between 2011–2016. After data collection, patients that were guided to best medical treatment (BMT) were encompassed in Group I, those allocated to carotid endarterectomy (CEA) plus BMT were on Group II and those allocated to carotid stenting (CAS) plus BMT were on Group III. Afterwards we proceeded with a statistical analysis of the results obtained concerning outcomes during follow-up.

Results: Group I included 38 patients, 25 males, with a mean age of 74,5 years old. During first year follow-up, was regis- tered one stroke and two transient ischemic attack (TIA) accounting three events (7,9%). Relatedly, 8 patients (21%) died of non-related cause. Group II included 29 patients, 24 males, with a mean age of 72 years old. As peri-operative outcomes was registered two strokes, one causing the death of the patient, accounting two events (6,5%). Finally, in Group III were included 19 patients, 14 males, with a mean age of 76,3 years old. As peri-operative outcomes were registered two strokes, one leading to the death of the patient, accounting two events (10.5%).

Discussion/Conclussion: We found a significant statistical difference (p=0,038) favouring BMT plus CEA in place of Stenting plus BMT in accord with already published evidence. Despite higher events registered in the BMT Group, the difference, when compared to CEA plus BMT was not substantial (p=0,67).
Despite the reduced pool of patients analysed requiring further studies, according to these results, we believe that once presented with a patient with symptomatic MCS, CEA plus BMT should be offered whenever possible. Still, we consider that there may exist some high risk for CEA patients in whom we should allocate to BMT alone and repetitive re-evaluation considering CEA when neurological stabilization.

Downloads

Download data is not yet available.

References

1. A R Naylor et al, Editor’s Choice e Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guide- lines of the European Society for Vascular Surgery (ESVS); Eur J Vasc Endovasc Surg (2018) 55, 3e81
2. European Carotid Surgery Trialists’ Collaborative Group. MRC Euro- peanCarotidSurgeryTrial:interimresultsforsymptomaticpatients with severe (70e99%) or with mild (0e29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet 1991;337:1235e43.
3. North American Symptomatic Carotid Endarterectomy Trial Collabo- rators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. N Engl J Med 1991;325:445e53.
4. MaybergMR,WilsonSE,YatsuF,WeissDG,MessinaL,HersheyLA,et al. Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. Veterans Affairs Cooperative Studies Program 309 Trialist Group. JAMA 1991;266:3289e94.
5. Naylor AR, Bolia A, Abbott RJ, Pye IF, Smith J, Lennard N, et al. Rando- mized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 1998;28: 326e34.
6. Alberts MJ. Results of a multicentre prospective randomized trial of carotid artery stenting vs carotid endarterectomy. Stroke 2001;32:325.
7. Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L. Carotid angioplasty and stenting versus carotid endarterec- tomy: randomized trial in a community hospital. J Am Coll Cardiol 2001;38:1589e95.
8. Hoffmann A, Engelter S, Taschner C, Mendelowitsch A, Merlo A, Radue EW, et al. Carotid artery stenting versus carotid endarterec- tomy e a prospective randomized controlled single-centre trial with long-term follow up (BACASS). Schweizer Archiv für Neurologie und Psychiatrie 2008;159:84e9.
9. Mas JL, Trinquart L, Leys D, Albucher JF, Rousseau H, Viguier A, et al. EVA-3S investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008;7:885e92.
10. Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 2008;7:893e902.
11. CAVATAS investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Lancet 2001;357:1729e37.
12. Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, et al. Carotid artery stenting compared with endarte- rectomy in patients with symptomatic carotid stenosis (Interna- tional Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 2010;375:985e97.
13. Steinbauer MG, Pfister K, Greindl M, Schlachetzki F, Borisch I, Schuirer G, et al. Alert for increased long-term follow-up after carotid artery stenting: results of a prospective, randomized, single enter trial of carotid artery stenting vs carotid end- arterectomy. J VascSurg2008;48:93e8.
14. A.R. Naylor et al; Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS); Eur J Vasc Endovasc Surg (2018) 55, 3e81
15. Hopkins LN, Rougin GS, Chakhtoura EY, et al. The Carotid Revas- cularization Endarterectomy versus Stenting Trial: credentialing of interventionalists and final results of lead-in phase. J Stroke Cerebrovasc Dis. 2010;19:153–162.
16. Hobson RW., II CREST (Carotid Revascularization Endarterectomy versus Stent Trial): background, design, and current status. Semin Vasc Surg. 2000;13:139–143.
17. Moore WS, Vescera CL, Robertson JT, Baker WH, Howard VJ, Toole JF. Selection process for surgeons in the Asymptomatic Carotid Atherosclerosis Study. Stroke. 1991;22:1353–1357
18. Aronow HD, Gray WA, Ramee SR, Mischkel GJ, Schreiber TJ, Wang H. Predictors of neurological events associated with carotid artery stenting in high surgical risk patients: insights from the Cordis Carotid Stent Collaborative. Circ Cardiovasc Interv 2010;3:577e84
19. Truelsen B, Piechowski-Jozwiak T, Bonita R, Mathersa C, Bogouss- lavsky J, Boysen G. Stroke incidence and prevalence in Europe. Eur Neurol 2006;13:581e98
20. Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Scarborough P, Rayner M. European cardiovascular disease statistics 2012. Sophia Antipolis: European Heart Network, Brussels, European Society of Cardiology. www.escardio.org/ static_file/.../EU-Cardiovascu- lar-disease-statistics-2012.pdf. [Accessed 20 July 2017]. 4 Royal College of Physicians Nat
21. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR,etal.CarotidEndarterectomyTrialists’Collaboration.Analysis of pooled data from the randomised controlled trials of endarterec- tomy for symptomatic carotid stenosis. Lancet 2003;361:107e16.
22. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Carotid EndarterectomyTrialistsCollaboration.Endarterectomyforsymp- tomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915e24.
23. Rerkasem K, et al; Systematic review of the operative risks of carotid endarterectomy for recently symptomatic stenosis in relation to the timing of surgery. Stroke 2009; 40e564-72
24. Rothwell PM, Gutnikov SA, Warlow CP. European Carotid Surgery Trialist’s Collaboration. Sex differences in the effect of time from symptoms to surgery on benefit from carotid endarterectomy for transient ischaemic attack and non disabling stroke. Stroke 2004;35:2855e61.
25. COULL AJ, LOVETT JK, ROTHWELL PM. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ. 2004;328:326-328.

Published

2019-12-27

How to Cite

1.
Sousa PP, Lopes G, Teixeira G, Almeida R, Sá Pinto P. SYMPTOMATIC MODERATE CAROTID STENOSIS (50–69%) — RETROSPECTIVE ANALYSIS. Angiol Cir Vasc [Internet]. 2019 Dec. 27 [cited 2024 Mar. 28];15(3):188-94. Available from: https://acvjournal.com/index.php/acv/article/view/155

Issue

Section

Original Article