Open AccessLength of carotid stenosis predicts peri‐procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
Author(s) -
Bonati Leo H.,
Ederle Jörg,
Dobson Joanna,
Engelter Stefan,
Featherstone Roland L.,
Gaines Peter A.,
Beard Jonathan D.,
Venables Graham S.,
Markus Hugh S.,
Clifton Andrew,
Sandercock Peter,
Brown Martin M.
Publication year - 2014
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/ijs.12084
Subject(s) - medicine , restenosis , stenosis , carotid endarterectomy , stroke (engine) , endarterectomy , angioplasty , carotid stenting , randomized controlled trial , cardiology , hazard ratio , odds ratio , surgery , stent , confidence interval , mechanical engineering , engineering
Background The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. Methods In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n = 213) or carotid endarterectomy ( n = 211) in the C arotid and V ertebral A rtery T ransluminal A ngioplasty S tudy (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis ≥50% during follow‐up. Results Carotid stenosis longer than 0·65 times the common carotid artery diameter was associated with increased risk of peri‐procedural stroke or death after both endovascular treatment [odds ratio 2·79 (1·17–6·65), P = 0·02] and carotid endarterectomy [2·43 (1·03–5·73), P = 0·04], and with increased long‐term risk of restenosis in endovascular treatment [hazard ratio 1·68 (1·12–2·53), P = 0·01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P = 0·003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. Conclusions Increasing stenosis length is an independent risk factor for peri‐procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials.