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Chirurgie 6. August 2015

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

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.

M. Aspalter, K. Linni, A. Ugurluoglu, W. Hitzl, T. Hölzenbein, European Surgery 4/2015

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