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Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

Bonati LH, Ederle J, Dobson J, Engelter S, Featherstone RL, Gaines PA, Beard JD, Venables GS, Markus HS, Clifton A, Sandercock P, Brown MM, CAVATAS Investigato - Int J Stroke (2013)

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.

View Article: PubMed Central - PubMed

Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.

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Cumulative incidence of restenosis ≥50% in both treatment arms, according to length of stenosis at baseline. Threshold length of stenosis was 0.65 times the diameter of the distal common carotid artery, using the definition of length 2 (see text for details). The interaction between length of stenosis, treatment, and restenosis was significant (P = 0.003). EVT, endovascular treatment; CEA, endarterectomy; HR, hazard ratio (95% confidence interval).
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fig05: Cumulative incidence of restenosis ≥50% in both treatment arms, according to length of stenosis at baseline. Threshold length of stenosis was 0.65 times the diameter of the distal common carotid artery, using the definition of length 2 (see text for details). The interaction between length of stenosis, treatment, and restenosis was significant (P = 0.003). EVT, endovascular treatment; CEA, endarterectomy; HR, hazard ratio (95% confidence interval).

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).


Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy.

Bonati LH, Ederle J, Dobson J, Engelter S, Featherstone RL, Gaines PA, Beard JD, Venables GS, Markus HS, Clifton A, Sandercock P, Brown MM, CAVATAS Investigato - Int J Stroke (2013)

Cumulative incidence of restenosis ≥50% in both treatment arms, according to length of stenosis at baseline. Threshold length of stenosis was 0.65 times the diameter of the distal common carotid artery, using the definition of length 2 (see text for details). The interaction between length of stenosis, treatment, and restenosis was significant (P = 0.003). EVT, endovascular treatment; CEA, endarterectomy; HR, hazard ratio (95% confidence interval).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232022&req=5

fig05: Cumulative incidence of restenosis ≥50% in both treatment arms, according to length of stenosis at baseline. Threshold length of stenosis was 0.65 times the diameter of the distal common carotid artery, using the definition of length 2 (see text for details). The interaction between length of stenosis, treatment, and restenosis was significant (P = 0.003). EVT, endovascular treatment; CEA, endarterectomy; HR, hazard ratio (95% confidence interval).
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).

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.

View Article: PubMed Central - PubMed

Affiliation: Stroke Research Group, UCL Institute of Neurology, London, UK; Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland.

Show MeSH
Related in: MedlinePlus