News | Stents Carotid | June 17, 2015

New Research Explores "Myth" of Restenosis After Carotid Angioplasty and Stenting

Restenosis rates vary but are higher for patients with history of carotid endarterectomy or neck irradiation

June 17, 2015 - Karam Moon, M.D., winner of the DePuy Synthes Cerebrovascular Section Resident/Fellow Award, presented his research, The Myth of Restenosis after Carotid Angioplasy and Stenting, at the American Association of Neurological Surgeons (AANS) annual scientific meeting in May.

Carotid endarterectomy and stenting was shown to have similar safety and efficacy in the Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis Trial (CREST). Restenosis rates after endovascular treatment are highly variable in the literature and risk factors for this pathology are poorly understood.

The study's authors reviewed all patients undergoing carotid artery stenting (CAS) between 1995 and 2010. Symptomatic and asymptomatic patients were selected based on North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS) criteria. Risk factors, indications, rates of technical success, intraoperative and perioperative complications, restenosis (>50 percent) rate and clinical outcomes were evaluated.

A total of 156 patients met inclusion criteria, but 35 were lost to follow-up, leaving 121 patients with 133 vessels treated. Ninety-one (68.4 percent) lesions were symptomatic. Indications for stent placement included patients who were poor surgical candidates, prior endarterectomy, prior radiation, study randomization, acute occlusions, tandem stenosis, high bifurcation and contralateral laryngeal nerve palsy.

Procedures were technically successful in all but one case. Intraoperative and peri-operative stroke occurred in four patients (3 percent). Mean follow-up was 38 months (range one to 204 months). Patients with a prior history of carotid endarterectomy or neck irradiation (hostile-neck) (n=57) comprised 42.9 percent of all vessels treated and were responsible for 15 of 23 restenosis cases, resulting in a significantly higher restenosis rate when compared with primary atherosclerosis lesions (26.3 percent vs. 10.5 percent, P=.017). Five patients (3.8 percent) with restenosis were symptomatic, four of whom were part of the hostile-neck group.

Rates of in-stent restenosis after carotid angioplasty and stenting are low, but differ between patients with atherosclerotic and hostile-neck etiologies. In this large modern series of carotid artery stenting at a high-volume institution, nearly half of lesions treated were hostile-neck carotids, a cohort that is at higher risk for substantial radiographic and symptomatic restenosis. Counseling for patients undergoing CAS should reflect the differences between these distinct pathologies.

For more information: www.aans.org

Related Content

MyoKardia Presents Additional Positive Data From Phase 2 PIONEER-HCM Study at HFSA 2017
News | Heart Failure| September 21, 2017
MyoKardia Inc. announced that additional positive data from the first patient cohort of its Phase 2 PIONEER-HCM study...
Tryton Side Branch Stent Recognized With Premier Technology Breakthrough Award
News | Stents Bifurcation| September 21, 2017
September 21, 2017 — Cardinal Health and Tryton Medical Inc.
DISRUPT BTK Study Shows Positive Results With Lithoplasty in Calcified Lesions Below the Knee
News | Peripheral Artery Disease (PAD)| September 20, 2017
Shockwave Medical reported positive results from the DISRUPT BTK Study, which were presented at the annual...
Gecko Biomedical Receives CE Mark Approval for Setalum Sealant
News | Cardiovascular Surgery| September 19, 2017
Gecko Biomedical announced it has received CE Mark approval for its Setalum Sealant, allowing the company to market its...
Corindus Announces First Patient Enrolled in PRECISION GRX Registry
News | Robotic Systems| September 18, 2017
September 18, 2017 — Corindus Vascular Robotics Inc.
Two-Year ILLUMENATE Trial Data Demonstrate Efficacy of Stellarex Drug-Coated Balloon
News | Drug-Eluting Balloons| September 18, 2017
Philips announced the two-year results from the ILLUMENATE European randomized clinical trial (EU RCT) demonstrating...
Sentinel Cerebral Protection System Significantly Reduces Stroke and Mortality in TAVR
News | Embolic Protection Devices| September 18, 2017
September 18, 2017 – Claret Medical announced publication of a new study in the...
Fysicon Receives FDA Approval for QMAPP Hemodynamic Monitoring System
Technology | Hemodynamic Monitoring Systems| September 18, 2017
Fysicon announced that it has been granted 510(k) clearance by the U.S. Food and Drug Administration (FDA) for its...
Marijuana Associated With Three-Fold Risk of Death From Hypertension
News | Hypertension| September 14, 2017
Marijuana use is associated with a three-fold risk of death from hypertension, according to research published recently...
Peter Schneider, M.D. presents late breaking clinical trial results at VIVA 17 in Las Vegas. Panelists (l to r) Krishna Rocha-Singh, M.D., Sean Lyden, M.D., John Kaufman, M.D., Donna Buckley, M.D.

Peter Schneider, M.D. presents late breaking clinical trial results at VIVA 17 in Las Vegas. Panelists (l to r) Krishna Rocha-Singh, M.D., Sean Lyden, M.D., John Kaufman, M.D., Donna Buckley, M.D.

Feature | Cath Lab| September 14, 2017
September 14, 2017 — Here are quick summaries for all the key late-breaking vascular and endovascular clinical trials
Overlay Init