Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study.

Autor:	Garcia-Pastor A; From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain angarpas@yahoo.es., Gil-Núñez A; From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain., Ramirez-Moreno JM; Department of Neurology (J.M.R.-M.), Hospital Universitario Infanta Cristina, Badajoz, Spain., González-Nafría N; Department of Neurology (N.G.-N., J.T.), Complejo Asistencial Universitario de León, Neurology, Leon, Spain., Tejada J; Department of Neurology (N.G.-N., J.T.), Complejo Asistencial Universitario de León, Neurology, Leon, Spain., Moniche F; Department of Neurology (F.M.), Hospital Universitario Virgen del Rocío, Sevilla, Sevilla, Spain., Portilla-Cuenca JC; Department of Neurology (J.C.P.-C.), Hospital San Pedro Alcántara, Cáceres, Spain., Martínez-Sánchez P; Department of Neurology (P.M.-S., B.F.), Hospital Universitario La Paz, Madrid, Spain., Fuentes B; Department of Neurology (P.M.-S., B.F.), Hospital Universitario La Paz, Madrid, Spain., Gamero-García MA; Department of Neurology (M.A.G.-G.), Hospital Universitario Virgen Macarena, Sevilla, Spain., de Leciñana MA; Department of Neurology (M.A.d.L., J.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain., Masjuan J; Department of Neurology (M.A.d.L., J.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain., Verge DC; Department of Neurology (D.C.V.), Corporació Sanitaria Parc Taulí, Sabadell, Spain., Aladro Y; Department of Neurology (Y.A.), Hospital Universitario de Getafe, Getafe, Spain., Parkhutik V; Department of Neurology (V.P., A.L.), Hospital Universitari La Fe, Valencia, Spain., Lago A; Department of Neurology (V.P., A.L.), Hospital Universitari La Fe, Valencia, Spain., de Arce-Borda AM; Department of Neurology (A.M.d.A.-B), Hospital Universitario de Donostia, Donostia, Spain., Usero-Ruiz M; Department of Neurology (M.U.-R.), Hospital Universitario de Valladolid, Valladolid, Spain., Delgado-Mederos R; Department of Neurology (R.D.-M.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain., Pampliega A; Department of Neurology (A.P.), Hospital General Univeristario de Alicante, Alicante, Spain., Ximenez-Carrillo Á; Department of Neurology (Á.X.-C.), Hospital Universitario de La Princesa, Madrid, Spain., Bártulos-Iglesias M; Department of Neurology (M.B.-I.), Hospital Universitario de Burgos, Burgos, Spain., Castro-Reyes E; From the Department of Neurology (A.G.-P., A.G.-N., E.C.-R.), Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2022 Sep; Vol. 43 (9), pp. 1304-1310. Date of Electronic Publication: 2022 Aug 18.
DOI:	10.3174/ajnr.A7617
Abstrakt:	Background and Purpose: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. Materials and Methods: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. Results: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy ( P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% ( P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment ( P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively ( P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively). Conclusions: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment. (© 2022 by American Journal of Neuroradiology.)
Databáze:	MEDLINE
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