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Home > Vascular Annual Meeting > PP1. Primary Carotid Artery Stenting vs. Carotid Artery...

PP1. Primary Carotid Artery Stenting vs. Carotid Artery Stenting for Post-Carotid Endarterectomy Restenosis: Early and Late Outcomes

Ali F. AbuRahma1, Shadi Abu-Halimah1, Jessica Bensenhaver1, Aravinda Nanjundappa1, Patrick A. Stone1, L. Scott Dean2, Tammi Keiffer2, Mary Emmett2, Zachary AbuRahma1
1Robert C. Byrd Health Sciences Center of W. Va. University, Charleston, WV; 2Charleston Area Medical Center, Charleston, WV

OBJECTIVES: Carotid artery stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in high-risk surgical patients, including restenosis after CEA. This is the first study to compare early and late clinical outcomes for primary CAS versus CAS for post-CEA restenosis.

METHODS: This study analyzes 180 high-risk surgical patients: 68 had primary CAS (Group A) and 112 had CAS for post-CEA restenosis (Group B [redo]). Patients were followed prospectively and had duplex ultrasounds at one month, and every six months thereafter.

RESULTS: Demographic/clinical characteristics were comparable for both groups. Mean follow-up was 25 months (range: 1-78). The technical success rate was 100%. Perioperative stroke rates and combined stroke/death/MI rates were 7.4% for Group A versus 0.9% for Group B (p=0.0294). There was no perioperative MI, with one death secondary to stroke. The combined early and late stroke rates for Groups A and B were 10.8% and 1.8%, respectively (p=0.0275). Stroke-free rates at 1, 2, 3, and 4 years for Groups A and B were 89%, 89%, 89%, and 89%; and 98%, 98%, 98%, and 98%, respectively (p=0.0105, Figure 1). Two patients (3%) in Group A and seven patients (6%) in Group B had ≥80% in-stent restenosis (all were asymptomatic except one). Freedom from ≥80% in-stent restenosis at 1, 2, 3, and 4 years for Groups A and B were 100%, 98%, 98%, and 78%, versus 99%, 96%, 92%, and 87%, respectively (p=0.7005). Freedom from target vessel revascularization rates at 1, 2, 3, and 4 years for Groups A and B were 100%, 100%, 100%, and 100% versus 99%, 97%, 97%, and 92%, respectively (p=0.261).

CONCLUSIONS: CAS for CEA restenosis was safer than primary CAS, however both had similar in-stent restenosis rates.

AUTHOR DISCLOSURES: A.F. AbuRahma, None; S. Abu-Halimah, None; J. Bensenhaver, None; A. Nanjundappa, None; P.A. Stone, None; L.S. Dean, None; T. Keiffer, None; M. Emmett, None; Z. AbuRahma, None.

Figure 1.