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Erschienen in: European Surgery 4/2015

01.08.2015 | Original Article

Patch, interposition graft or stent for treatment of restenosis after carotid endarterectomy: a retrospective study

verfasst von: M. Aspalter, MD, K. Linni, A. Ugurluoglu, MD, W. Hitzl, T. Hölzenbein

Erschienen in: European Surgery | Ausgabe 4/2015

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Summary

Background

Uncertainty surrounding the indication for treatment of post carotid-endarterectomy restenosis (pCEAR) exists. Conventional patch angioplasty (rCEA), carotid interposition graft (CIG), and stent-assisted angioplasty (CAS) have been studied; comparisons of these techniques have not been performed.

Methods

A time to event analysis of consecutive patients undergoing treatment for pCEAR was performed. Primary end-point was any cerebrovascular or myocardial event or death. Long-term results were expressed in Kaplan–Meier estimates.

Results

From 02/1997 to 03/2013, 93 procedures for severe pCEAR were performed in 89 consecutive patients. Group 1 consisted of 37 rCEA (40 %), group 2 included 33 CIG (35 %), and group 3 contained 23 CAS (25 %). Median time from primary CEA was significantly longer in group 2 compared with group 3 (118 vs. 54 months; p = 0.02). Groups were comparable with regard to degree of stenosis and cardiovascular risk factors. Five patients (6 %) underwent initial angiography with intention of CAS, but the procedures could not be completed (insufficient access n = 3, neurological symptoms n = 2) and open surgery was performed (rCEA: n = 4; CIG: n = 1). One perioperative death related to major stroke occurred in group 3 (3.6 %). There were no differences in 4-year estimated survival and event-free survival, whereas patients in group 3 were more likely to undergo a tertiary intervention (13 % at 4 years 95 % CI: 11–45 % p = 0.014).

Conclusions

All three groups presented with similar long-term outcome with regard to the predefined endpoints. Although associated with less perioperative complications, CAS required significantly more tertiary interventions. Carotid interposition graft was not superior to redo patch plasty.
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Metadaten
Titel
Patch, interposition graft or stent for treatment of restenosis after carotid endarterectomy: a retrospective study
verfasst von
M. Aspalter, MD
K. Linni
A. Ugurluoglu, MD
W. Hitzl
T. Hölzenbein
Publikationsdatum
01.08.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0323-y

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