Comparison of carotid endarterectomy and stenting for symptomatic internal carotid artery near-occlusion

J. Kim*, S. Male, D. Damania, B. S. Jahromi, R. P. Tummala

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion. MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow- up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis. RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20% restenosis and 79% vessel maturation rates, while patients with carotid endarterectomy had 17.4% restenosis and 84% vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures. CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.

Original languageEnglish (US)
Pages (from-to)1207-1212
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume40
Issue number7
DOIs
StatePublished - Jul 1 2019

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Carotid Endarterectomy
Internal Carotid Artery
Carotid Arteries
Carotid Stenosis
Diagnostic Imaging
Medical Records
Ultrasonography
Databases
Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

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title = "Comparison of carotid endarterectomy and stenting for symptomatic internal carotid artery near-occlusion",
abstract = "BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion. MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow- up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis. RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20{\%} restenosis and 79{\%} vessel maturation rates, while patients with carotid endarterectomy had 17.4{\%} restenosis and 84{\%} vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures. CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.",
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Comparison of carotid endarterectomy and stenting for symptomatic internal carotid artery near-occlusion. / Kim, J.; Male, S.; Damania, D.; Jahromi, B. S.; Tummala, R. P.

In: American Journal of Neuroradiology, Vol. 40, No. 7, 01.07.2019, p. 1207-1212.

Research output: Contribution to journalArticle

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T1 - Comparison of carotid endarterectomy and stenting for symptomatic internal carotid artery near-occlusion

AU - Kim, J.

AU - Male, S.

AU - Damania, D.

AU - Jahromi, B. S.

AU - Tummala, R. P.

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N2 - BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion. MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow- up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis. RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20% restenosis and 79% vessel maturation rates, while patients with carotid endarterectomy had 17.4% restenosis and 84% vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures. CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.

AB - BACKGROUND AND PURPOSE: Carotid near-occlusion is defined as severe stenosis of the internal carotid artery with partial or full collapse of the distal vessel wall. The major studies evaluating carotid revascularization excluded patients with carotid near-occlusion. Given the paucity of data in the literature, we attempted to evaluate the safety of carotid endarterectomy and carotid artery stenting in carotid near-occlusion. MATERIALS AND METHODS: A retrospective data base review was performed from January 2010 to December 2018 to identify patients who underwent carotid endarterectomy or carotid artery stenting for symptomatic ICA near-occlusion and had 1-month clinical and imaging follow- up with carotid sonography. The medical records and imaging studies of patients with ICA near-occlusion were selected for analysis. RESULTS: Forty-five patients met the criteria for ICA near-occlusion, of whom 39 were included in the study, given insufficient 1-month follow-up on 6 patients. Of the 39 patients, 25 underwent carotid endarterectomy and 14 underwent carotid artery stenting. All patients had technically successful immediate revascularization of the ICA. Most (33 of 39) had 1-year follow-up postoperatively. Patients with carotid artery stenting had 20% restenosis and 79% vessel maturation rates, while patients with carotid endarterectomy had 17.4% restenosis and 84% vessel maturation. There was no significant difference in periprocedural complication rates between the 2 procedures. CONCLUSIONS: Carotid artery stenting shows similar outcomes in restenosis and vessel maturation rates compared with carotid endarterectomy for ICA near-occlusion. There were no major differences between the 2 treatments in clinical outcomes or periprocedural complications. Carotid artery stenting is a revascularization option for carotid near-occlusion if the patient is considered at high risk for carotid endarterectomy.

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