SS08. A Propensity-Matched Comparison for Open and Endovascular Treatment of Postcarotid Endarterectomy (CEA) Restenosis

Abstract

This study compared early and late results of open and endovascular management of postcarotid endarterectomy (CEA) restenosis in a retrospective single-center matched case control study. From January 2005 to December 2015, 147 consecutive elective interventions for post-CEA restenosis were performed in our institution. A retrospective analysis of clinical records was performed, and 80 interventions carried out with carotid artery stenting (CAS) were found, while the remaining 67 interventions were open. Propensity score-based matching was performed to adjust for confounding factors in a 1:1 ratio to compare outcomes. Covariates included coronary artery disease, degree of the carotid restenosis, timing of the reintervention with respect to the primary intervention (higher or lower than 24 months), and the presence of ipsilateral brain lesions at the preoperative computed tomography scan. Perioperative outcomes were analyzed with the χ2 test, and late results were estimated by Kaplan-Meier methods. After propensity matching, 32 CAS interventions (group 1) were matched with 32 redo CEAs (group 2). There were no perioperative deaths or strokes; two patients in group 2 experienced a perioperative transient ischemic attack and an acute myocardial infarction, respectively. Cranial nerve palsy occurred in seven patients in group 2; in six of them, complete regression was found at a 1-month follow-up otolaryngologist visit. All patients had an available follow-up, with a mean duration of 41 months (range, 6-120 months); the mean follow-up index was 0.72 (range, 0.1-1). Estimated 4-year survival rates were 93% (standard error [SE], 0.06%) in group 1 and 88.5% (SE, 0.06%) in group 2 (P = .1; log-rank, 2.6). There were no differences between the two groups in stroke-free survival and any neurologic symptom-free survival. In group 1, no severe (>70%) restenoses were found, while in group 2, eight patients had severe restenosis or occlusion of the operated carotid artery. Freedom from secondary restenosis at 4 years was 100% in group 1 and 71.5% in group 2 (SE, 0.08%; P = .004, log-rank, 8.2). The corresponding figures in freedom from secondary reintervention were 100% and 83% (SE, 0.07%; P = .02, log-rank, 5). CAS and redo CEA in patients with post-CEA restenosis provided in this retrospective single-center experience similar perioperative results in equivalent groups of patients. CAS patients had better follow-up results in secondary restenosis and reinterventions; this fact, along with the not negligible rate of perioperative cranial nerve palsy in redo CEA patients, suggest a primary role for CAS in such a condition.