Periprocedural clinical outcomes of stenting and endarterectomy in patients with carotid artery stenosis

Yıl 2024, Cilt: 49 Sayı: 3, 744 - 750, 30.09.2024

Derya Özdoğru , Onur Kadir Uysal , İlker Öztürk , Candan Cudi Ökten , Burak Ademoğlu , Zülfikar Arlıer

https://doi.org/10.17826/cumj.1493108

Öz

Purpose: To identify the chief pathological cause of extracranial cerebrovascular disease, which is atherosclerosis, we analyzed and compared the early and 6-month morbidity and mortality rates of patients who underwent carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis.
Materials and Methods: We retrospectively included patients who had undergone surgical endarterectomy and endovascular carotid stent implantation for carotid artery stenosis between April 2019 and August 2022. We evaluated neurological examinations, routine blood tests, neurological and systemic complications, mortality rates, and follow-up colour Doppler ultrasonography 6 months post-discharge.
Results: The study included a total of 300 patients, with 52.7% (n = 158) undergoing CEA and 47.3% (n = 142) undergoing endovascular stent implantation (CAS). The patients’ average ages were 66±8 years in the CEA group and 70±7.4 years in the CAS group, suggesting that those undergoing CAS were generally older. Notably, there were significantly more instances of congestive heart failure and a history of cerebrovascular disease within the CAS group compared to the CEA group. However, no significant difference was observed in the rates of postprocedural complications. Furthermore, there were no cases of mortality reported in either group.
Conclusion: The preferred method for treating severe carotid artery stenosis should be determined by considering patient characteristics and preferences, as well as the complication rates in the centre.

Anahtar Kelimeler

carotid endarterectomy, carotid artery stenting, carotid artery stenosis, restenosis

Destekleyen Kurum

yok

Teşekkür

yok

Karotis arter darlığı olan hastalarda uygulanan stent ve endarterektominin işlem sürecindeki klinik sonuçları

Öz

Amaç: Ekstrakraniyal serebrovasküler hastalığın primer patolojik nedeni aterosklerozdur. Karotis arter darlığı nedeniyle karotis endarterektomi (CEA) ve karotis arter stentleme (CAS) yapılan hastaların erken ve ilk 6 aylık morbidite ve mortalite sonuçlarını karşılaştırdık.
Gereç ve Yöntem: Nisan 2019 ile Ağustos 2022 tarihleri arasında karotis arter darlığı nedeniyle cerrahi endarterektomi ve endovasküler karotis stent implantasyonu uygulanan 300 hasta retrospektif olarak çalışmaya dahil edildi. Nörolojik muayeneler, rutin kan testleri, nörolojik ve sistemik komplikasyonlar, mortalite oranları ve taburcu olduktan 6 ay sonraki renkli doppler ultrasonografi takipleri retrospektif olarak değerlendirildi.
Bulgular: Karotis endarterektomi (CEA) uygulanan %52,7 (n = 158) ve endovasküler stent implantasyonu (CAS) uygulanan %47,3 (n = 142) olmak üzere toplam 300 hasta çalışmaya dahil edildi. Hastaların yaş dağılımı CEA grubunda 66±8 yıl ve CAS grubunda 70±7,4 yıl olup, CAS uygulanan hastalar daha yaşlıydı. Konjestif kalp yetmezliği tanısı ve serebrovasküler hastalık öyküsü CAS grubunda CEA grubuna göre anlamlı olarak daha yaygındı. İşlem sonrası komplikasyon oranlarında anlamlı bir fark yoktu. Her iki grupta da mortalite gözlenmedi.
Sonuç: Ciddi karotis arter stenozunun tedavisinde seçilecek yöntemin hasta özellikleri ve tercihinin yanı sıra merkezdeki komplikasyon oranları da göz önünde bulundurularak yapılması uygun olacaktır.

Anahtar Kelimeler

Karotis endarterektomi, karotis arter stentleme, karotis arter darlığı, restenoz

Kaynakça

• Goldstein LB. Introduction for focused updates in cerebrovascular disease. Stroke. 2020;51:708-10.
• Rothwell PM, Eliasziw M, Gutnikov SA, Fox A, Taylor D, Mayberg M et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107–16.
• Economopoulos KP, Sergentanis TN, Tsivgoulis G, Mariolis AD, Stefanadis C. Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes. Stroke. 2011;42:687–92.
• Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351:1379-87.
• Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, Borst GJ et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interimanalysis of a randomised controlled trial. Lancet. 2010;375:985-97.
• Boztosun B, Can MM, Kocabay G. Karotis arter endarterektomisine karşı karotis artere stent: Bugün nerede duruyoruz? Turk Kardiyol Dern Ars. 2012;40:642-9.
• Halliday A, Bulbulia R, Bonati LH, Chester J, Cradduck-Bamford A, Peto R et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet 2021;398:1065–73.
• Faries PL, Chaer RA, Patel S, Lin SC, DeRubertis B, Kent KC et al. Current management of extracranial carotid artery disease. Vasc Endovasc Surg. 2006;40:165-75.
• Setacci C, Sterpetti A, de Donato G. Introduction: Carotid endarterectomy versus carotid stenting-A never-ending story. Semin Vasc Surg. 2018;31:1–3.
• Columbo JA, Martinez-Camblor P, MacKenzie TA, Kang R, Trooboff, SW, Goodney P et al. A comparative analysis of long-term mortality after carotid endarterectomy and carotid stenting. J Vasc Surg. 2019;69:104-9.
• Kumar R, Batchelder A, Saratzis A, AbuRahma AF, Ringleb P, Lal BK et al. Restenosis after carotid interventions and its relationship with recurrent ipsilateral stroke: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2017;53:766–75.
• Naylor AR, Ricco J-B, de Borst GJ, Debus S, de Haro J, Halliday A et al. Editor’s choice - management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:3–81.
• Hasan B, Farah M, Nayfeh T, Amin M, Malandris K, Abd-Rabu R et al. A systematic review supporting the society for vascular surgery guidelines on the management of carotid artery disease. J Vasc Surg. 2022;75:99S-108S.e42.
• Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery.. J Am Coll Cardiol. 2011;57:e16–94.
• Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from The American Heart Association/American Stroke Association. Stroke. 2014;45:2160–2236.
• Writing G, Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J et al. Editor’s choice - management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the european society for vascular surgery (esvs). Eur J Vasc Endovasc Surg. 2018;55:3–81.
• Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R et al. Heart disease and stroke statistics—2017 update: a report from the american heart association. Circulation 2017;135:e146–603.
• Reichmann BL, van Laanen JHH, de Vries J-PPM, Hendriks JM, Verhagen HJM, Moll FL et al. Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting. J Vasc Surg. 2011;54:87–92.
• Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W et al. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med 2016;374:1021–31.
• Behl D. In-Stent restenosis after carotid stenting. Sci Insights. 2022;41:625–30.
• Zinkstok SM, Roos YB. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet. 2012;380:731–7.
• Calvet D, Mas JL. Symptomatic carotid stenosis. Curr Opin Neurol. 2017;30:22–7.
• Greenstein AJ, Chassin MR, Wang J, Rockman CB, Riles TS, Tuhrim S et al. Association between minor and major surgical complication safter carotid endarterectomy: results of the New York carotid artery surgery study. J Vasc Surg. 2007;46:1138-46.
• SPACE Collaborative Group, Ringleb PA, Allenberg J, Brückmann H, Eckstein HH, Fraedrich G et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non inferiority trial. Lancet. 2006;368:1239-47.
• Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W et al. Results of the stent protected angioplasty versus carotid endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol. 2008;7:893-902.
• Paraskevas KI, Dardik A, Gloviczki P. Management of restenosis after carotid endarterectomy or stenting. Angiology. 2023;74:305-7.
• White CJ, Brott TG, Gray WA, Heck D, Jovin T, Lyden SP et al. Carotid artery stenting: JACC state of the art review. J Am Coll Cardiol. 2022;80:155-70.
• De Vries EE, Baldew VGM, den Ruijter HM, de Borst GJ. Meta-analysis of the costs of carotid artery stenting and carotid endarterectomy. Br J Surg. 2017;104:1284–92.