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

Lookup NU author(s): Dr Anil Gholkar OBE, Emeritus Professor David Mendelow, Dr Timothy Walls


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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 Carotid and Vertebral Artery Transluminal Angioplasty Study (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. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

Publication metadata

Author(s): Bonati LH, Ederle J, Dobson J, Engelter S, Featherstone RL, Gaines PA, Beard JD, Venables GS, Markus HS, Clifton A, Sandercock P, Brown MM, Bland JM, Brown MM, Buckenham T, Clifton A, Sandercock PAG, Taylor RS, Tognoni G, Warlow CP, Bleakley T, Colquhoun D, Coward L, Crawley F, Dobinson P, Featherstone R, Holder S, Markus H, McCabe DJH, Pereira A, Rogers J, Silver L, Burrett J, Crowther J, Dobson M, Hafner B, Heineman J, Hope C, Knight S, Naughten A, Radley A, Richards S, Smith D, Wenzel S, Harrison M, Ferro J, Beard J, Buckenham T, Brown MM, Clifton A, Bladin CF, Donnan GA, Fell G, Fitt G, Royle J, Davis S, Gerraty R, Mitchell P, Goodman MA, Hankey GJ, Khangure MS, Lawrence-Brown MM, Linto J, McAuliffe W, Prendergast FJ, Siennarine K, Stewart-Wynne EG, Grahovac S, Morrish W, Pageau N, E Pringle C, Richard DM, Malms J, Reiher L, Siebler M, Belloni G, Porta M, Chamorro A, Vila N, Riambau V, Vazquez F, Boza F, Garcia Rodriguez JL, Gil Peralta A, Gonzalez A, Gonzalez Marcos JR, Mayol Deya A, Rauno J, Kirsch EC, Lyrer PA, Rem JA, Bogousslavsky J, Uske A, Beard JD, Cleveland TJ, Doyle C, Gaines PA, Sivaguru A, Venables GS, Brown MM, Buckenham T, Clifton A, Colquhoun D, Crawley F, Leopold PW, Loosemore T, McCabe DJH, Pereira A, Rogers J, Taylor RS, Enevoldson TP, Gilling-Smith G, Harris P, Nixon T, Baskerville P, Cox T, Fraser S, Jeffrey M, Markus H, Molloy J, Butler P, Dick J, Frankel F, Bradbury A, Collie D, Murie JA, Ruckley CV, Sandercock PAG, Schultz D, Sellar RJ, Wardlaw J, Ashleigh RJ, McCollum CN, O'Neill P, Gholkar A, Mendelow AD, Walls TJ, Angus-Leppan H, Halpin S, Hughes J, Lane I, Wiles M, Wood AM, Birch PA, Earnshaw JJ, Fuller GN, Heather B, Poskitt K, Tottle AJ, Hope DT, Jefferson D, McConachie N, Duddy M, Heafield MTE, Vohra RK

Publication type: Article

Publication status: Published

Journal: International Journal of Stroke

Year: 2014

Volume: 9

Issue: 3

Pages: 297-305

Print publication date: 01/04/2014

Online publication date: 29/07/2013

Acceptance date: 01/01/1900

ISSN (print): 1747-4930

ISSN (electronic): 1747-4949

Publisher: Sage Publications Ltd


DOI: 10.1111/ijs.12084

PubMed id: 23895672


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