| Carotid angioplasty and stenting: treatment of postcarotid endarterectomy restenosis is at least as safe as primary stenosis treatment. | |
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MedLine Citation:
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PMID: 19576717 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study compared transcranial Doppler (TCD) imaging and outcomes of carotid angioplasty and stenting (CAS) in stenosis after carotid endarterectomy (CEA) vs primary atherosclerotic stenoses. METHODS: A prospectively accumulated database of 812 CAS procedures was analyzed retrospectively. Two groups were created. Group 1 had 72 restenoses at a mean of 71 months (range, 5-245 months) after initial CEA. Group 2 had 740 primary stenoses. Clinical end points were cerebral ischemic events and death. TCD end points were numbers of isolated microemboli and microembolic showers during five procedural phases. RESULTS: Groups 1 and 2 were evenly matched for demographic data: median age, 70 vs 71 years; 44 (61%) vs 525 men (71%); 14 (19%) vs 147 symptomatic (20%). Seven (0.9%) deaths and 10 major (1.2%) and 21 minor (2.6%) strokes occurred in group 2 (P = .049). Mean (standard deviation) numbers of isolated microemboli for groups 1 vs 2 were wiring, 37.0 (31.1) vs 50.4 (52.6); predilation, 14.8 (18.7) vs 21.7 (21.8); stent placement, 58.6 (31.1) vs 64.7 (38.8); postdilation, 20.4 (16.5) vs 27.2 (34.9), cerebral protection device (CPD) use, 44.2 (30.2) vs 37.5 (36.8); total, 134.8 (68.7) vs 175.3 (113.8). Microembolic showers: wiring, 1.7 (4.5) vs 2.2 (6.4); predilation, 2.1 (4.1) vs 3.3 (5.8); stent placement, 21.5 (22.0) vs 26.9 (25.1); postdilation, 5.3 (15.7) vs 5.0 (8.1); CPD use, 5.8 (6.9) vs 6.2 (8.9); total, 30.4 (36.0) vs 39.6 (35.0). TCD data for CPD use vs without for isolated emboli: wiring, 53.2 (45.1) vs 44.3 (51.7); predilation, 24.7 (20.2) vs 18.2 (22.5); stent placement, 77.5 (34.8) vs 53.5 (37.3); postdilation, 33.6 (36.6) vs 20.7 (21.8); CPD use, 38.3 (36.6) vs 0; total, 222.5 (113.8) vs 132.3 (89.1). Showers: wiring, 2.4 (6.6) vs 1.9 (5.8); predilation, 4.2 (6.4) vs 2.4 (5.0); stent placement, 38.9 (25.8) vs 16.2 (18.7); post-dilation, 7.0 (11.2) vs 3.4 (6.4); CPD use, 6.3 (8.9) vs 0; total, 58.4 (37.7) vs 23.3 (23.1). P = .01 for showers during wiring and P < .001 for all other variables. After correction for the difference in CPD use between groups 1 and 2 (17 out of 72 [24%] vs 369 out of 740 [50%]), no statistically significant differences remained in numbers of isolated emboli and embolic showers in the procedural phases or for the entire procedure. No statistically significant differences were found when TCD-detected microembolic load for early (<3 years between CEA and CAS) and late (>5 years) restenoses were compared. CONCLUSIONS: CAS for restenosis after CEA has a complication rate lower than primary CAS. The time interval between CEA and CAS did not influence micro embolic load. |
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Authors:
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Jan Albert Vos; Gert Jan de Borst; Tim T Overtoom; Jean Paul P de Vries; Eric D van de Pavoordt; Pieter Zanen; Rob G Ackerstaff; |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-07-03 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 50 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-29 Completed Date: 2009-10-15 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 755-761.e1 Citation Subset: IM |
Affiliation:
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Department of Interventional Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands. j.a.vos@antonius.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Balloon / methods* Carotid Stenosis / mortality, therapy*, ultrasonography Databases, Factual Endarterectomy, Carotid / adverse effects*, methods Female Follow-Up Studies Graft Occlusion, Vascular / therapy*, ultrasonography Humans Male Probability Prospective Studies Retreatment Risk Assessment Statistics, Nonparametric Stents* Stroke / prevention & control Survival Analysis Time Factors Treatment Outcome Ultrasonography, Doppler, Duplex Ultrasonography, Doppler, Transcranial Vena Cava Filters |
| Investigator | |
Investigator/Affiliation:
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Egbert T Bal / ; Jan A S van der Heyden / ; Maarten Jan Suttorp / ; Robin H Heijmen / ; Wim J Morshuis / ; Marc A A M Schepens / ; Rob G A Ackerstaff / ; Laurien L Teunissen / ; Selma C Tromp / ; Oscar J M Vogels / ; Henk W Mauser / ; Wouter J Schonewille / ; Johannes P M van Heesewijk / ; Marc van Leersum / ; Tim Th C Overtoom / ; Jan Albert Vos / ; Rob H van de Mortel / ; Henderik D W M van de Pavoordt / ; Jean Paul P M de Vries / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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