Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.
Bottom Line: 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.
Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.Show MeSH
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Mentions: Ultrasound follow-up was performed in 183 patients in the EVT arm and 176 patients in the CEA arm, for a median duration of 3.9 (IQR 1.8–5.3) and 4.3 (IQR 1.4–5.6) years, respectively. Restenosis ≥50% occurred significantly more often among patients treated endovascularly (99 patients) than those having undergone CEA (49 patients), with cumulative 5-year incidences of 60.1% (SE 4.3%) and 31.4% (SE 4.0%), respectively, and an overall HR of 2.63 (1.87–3.73; P < 0.001). In the EVT arm, patients with long baseline stenosis had a higher risk of restenosis than those with short stenosis [cumulative 5-year incidences 70.1% versus 53.8%, unadjusted HR 1.68 (1.12–2.53), P = 0.01; adjusted HR 1.65 (1.08–2.51), P = 0.02, Table 2]. In contrast, baseline length of stenosis was not associated with restenosis in the CEA arm. There was a significant interaction between length of stenosis, treatment, and restenosis (adjusted and unadjusted P = 0.003), showing that the excess in restenosis after EVT compared with CEA was significantly greater among patients with long carotid stenosis than with short carotid stenosis at baseline (Figs 4 and 5).
Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.