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High rate of restenosis after carotid artery stenting in patients with high-grade internal carotid artery stenosis

Medium-term follow-up

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Abstract

Objective

Carotid endarterectomy (CEA) is the goldstandard procedure for the majority of patients with high-grade symptomatic internal carotid artery stenosis and also for specified high-grade asymptomatic stenoses; however, a proportion of patients are treated with carotid endovascular therapy. We aimed to document medium-term clinical and neurosonographical outcome after carotid artery stenting (CAS).

Methods

53 patients (mean age: 65 ± 8 years) with high-grade (≥ 70 % by means of duplex sonography) carotid artery stenosis were enrolled into the study. Nineteen patients had asymptomatic, 34 patients had symptomatic stenoses. All patients had a pre-interventional CT, Doppler and duplex sonography, and digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) prior to the procedural DSA. All patients were offered CEA as the gold-standard procedure and as an alternative to CAS. Both clinical and Duplex sonographical follow-up was obtained at day 1 and 7, month 1, month 3, month 6, month 12, and every subsequent 6 months after the procedure. Mean follow-up time was 22 ± 1.6 months (± SEM).

Results

2/53 patients suffered from stroke. A further 2 patients suffered from carotid artery occlusion shortly after CAS. The cumulative rate of restenosis during follow-up was 24.5 % (13/53). Four of these (7.5 %) were of high-grade and led to further interventional or surgical therapy.

Conclusions

A high rate of restenosis was found during follow-up after CAS. Our analysis of non-selected patients emphasizes that CEA remains the gold-standard procedure for the treatment of symptomatic internal carotid artery stenosis. The frequently performed endovascular treatment of carotid stenosis outside the setting of a randomized controlled trial is not supported by our data.

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Authors and Affiliations

  1. Neurological Clinic, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany

    J. U. Harrer MD, R. Morschel &  C. M. Kosinski MD

  2. Dept. of Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany

    M. Mull MD

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  1. J. U. Harrer MD
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  2. R. Morschel
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  3. M. Mull MD
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  4. C. M. Kosinski MD
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Correspondence to J. U. Harrer MD.

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Harrer, J.U., Morschel, R., Mull, M. et al. High rate of restenosis after carotid artery stenting in patients with high-grade internal carotid artery stenosis. J Neurol 255, 1309–1314 (2008). https://doi.org/10.1007/s00415-008-0875-x

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  • DOI: https://doi.org/10.1007/s00415-008-0875-x

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