Document Detail


Natural history of carotid artery stenosis contralateral to endarterectomy: results from two randomized prospective trials.
MedLine Citation:
PMID:  14681599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: A few nonrandomized studies have reported the natural history of carotid artery stenosis (CAS) contralateral to carotid endarterectomy (CEA). This study analyzed this condition with data from two randomized prospective trials.
METHODS: The contralateral carotid arteries in 534 patients from two randomized trials that compared CEA with primary closure versus patching were followed up clinically and with duplex ultrasound scanning at 1 month and then every 6 months. CAS was classified as less than 50%, 50% to 79%, 80% to 99%, and occlusion. Late contralateral CEA was performed to treat significant CAS. Progression was defined as progress to a higher category of stenosis. Kaplan-Meier life table analysis was used to estimate freedom from progression of CAS. The correlation of risk factors and CAS progression was also analyzed.
RESULTS: Of 534 patients, 61 had initial contralateral CEA and 53 had contralateral occlusion. Overall, CAS progressed in 109 of 420 patients (26%) at mean follow-up of 41 months. Progression of CAS was noted in 5 of 162 patients (3%) with baseline normal carotid arteries. CAS progressed in 56 of 157 patients (36%) with less than 50% stenosis versus 45 of 95 patients (47%) with 50% to 79% stenosis (P =.003). Median time to progression was 24 months for less than 50% CAS, and 12 months for 50% to 79% CAS (P =.035). At 1, 2, 3, 4, and 5 years, freedom from disease progression in patients with baseline CAS <50% was 95%, 78%, 69%, 61%, 48%, respectively, and in patients with 50% to 79% CAS was 75%, 61%, 51%, 43%, and 33%, respectively (P =.003). Freedom from progression in patients with baseline normal carotid arteries at 1 through 5 years was 99%, 98%, 96%, 96%, and 94%, respectively. Late neurologic events referable to the CCA were infrequent (28 of 420 [6.7%] in the entire series; 28 of 258 [10.9%] patients with contralateral CAS), and included 10 strokes (2.4%) and 18 transient ischemic attacks (4.3%). However, late contralateral CEA was performed in 62 patients (62 of 420 [15%] in the entire series; 62 of 258 [24%] patients with contralateral CAS). Survival rates were 96%, 92%, 90%, 87%, and 82%, respectively, at 1 through 5 years.
CONCLUSIONS: Progression of CCA stenosis was noted in a significant number of patients with baseline contralateral CAS. Serial clinical studies and duplex ultrasound scanning every 6 to 12 months in patients with 50% to 79% CAS, and every 12 to 24 months in patients with 50% or less CAS is adequate.
Authors:
Ali F AbuRahma; Chris C Cook; Matthew J Metz; John T Wulu; Al Bartolucci
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  38     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-18     Completed Date:  2004-01-13     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1154-61     Citation Subset:  IM    
Affiliation:
Department of Surgery, Robert C. Byrd Health Sciences Center at West Virginia University, Charleston Area Medical Center, 3100 MacCorkle Avenue SE, Ste 603, Charleston, WV 25304, USA. Ali.aburahma@camc.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Carotid Stenosis / complications,  physiopathology*,  surgery*
Collateral Circulation / physiology*
Endarterectomy, Carotid*
Female
Follow-Up Studies
Humans
Ischemic Attack, Transient / etiology,  mortality,  physiopathology
Life Tables
Male
Middle Aged
Prospective Studies
Randomized Controlled Trials as Topic
Severity of Illness Index
Stroke / etiology,  mortality,  physiopathology
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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