Patch, interposition graft or stent for treatment of restenosis after carotid endarterectomy: a retrospective study

Abstract

Uncertainty surrounding the indication for treatment of post carotid-endarterectomy restenosis (pCEAR) exists. Conventional patch angioplasty (rCEA), carotid interposition graft (CIG), and stent-assisted angioplasty (CAS) have been studied; comparisons of these techniques have not been performed. A time to event analysis of consecutive patients undergoing treatment for pCEAR was performed. Primary end-point was any cerebrovascular or myocardial event or death. Long-term results were expressed in Kaplan–Meier estimates. From 02/1997 to 03/2013, 93 procedures for severe pCEAR were performed in 89 consecutive patients. Group 1 consisted of 37 rCEA (40 %), group 2 included 33 CIG (35 %), and group 3 contained 23 CAS (25 %). Median time from primary CEA was significantly longer in group 2 compared with group 3 (118 vs. 54 months; p = 0.02). Groups were comparable with regard to degree of stenosis and cardiovascular risk factors. Five patients (6 %) underwent initial angiography with intention of CAS, but the procedures could not be completed (insufficient access n = 3, neurological symptoms n = 2) and open surgery was performed (rCEA: n = 4; CIG: n = 1). One perioperative death related to major stroke occurred in group 3 (3.6 %). There were no differences in 4-year estimated survival and event-free survival, whereas patients in group 3 were more likely to undergo a tertiary intervention (13 % at 4 years 95 % CI: 11–45 % p = 0.014). All three groups presented with similar long-term outcome with regard to the predefined endpoints. Although associated with less perioperative complications, CAS required significantly more tertiary interventions. Carotid interposition graft was not superior to redo patch plasty.