Gaudry Marine, Bartoli Jean-Michel, Bal Laurence, Giorgi Roch, De Masi Mariangela, Magnan Pierre-Edouard, Piquet Philippe
APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France.
APHM, Hôpital Timone, Department of Radiology, 13005, Marseille, France.
PLoS One. 2016 Sep 9;11(9):e0161716. doi: 10.1371/journal.pone.0161716. eCollection 2016.
Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis.
We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death).
A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6-171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis.
We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
颈动脉支架置入术（CAS）已被提倡作为再次手术治疗颈动脉内膜剥脱术（CEA）后狭窄的替代方法。本研究分析了CAS治疗CEA后再狭窄的疗效，重点分析了支架内再狭窄的技术和解剖学预测因素。
我们进行了一项回顾性单中心研究。纳入1997年7月至2013年11月在我院接受CAS治疗CEA后再狭窄的所有患者。主要终点为技术成功率、随访期间支架内再狭窄>50%或闭塞（有症状或无症状）以及再狭窄的危险因素。次要终点为早期和晚期发病率及死亡率（短暂性脑缺血发作、中风、心肌梗死或死亡）。
共对153例CEA后再狭窄患者进行了CAS手术，主要原因是无症状病变（137/¹53）。技术成功率为98%。围手术期30天的中风和死亡率为2.6%（2例短暂性脑缺血发作和2例轻度中风），无症状和有症状患者的发生率分别为2.2%（3/137）和6.2%（1/16）。平均随访时间为36个月（范围6 - 171个月）。16例患者（10.6%）观察到支架内再狭窄或闭塞。仅1例患者观察到有症状的再狭窄。我们发现年轻（P = 0.002）、狭窄>85%（P = 0.018）以及颈总动脉缺乏支架覆盖（P = 0.006）是支架内再狭窄的独立预测因素。
我们确定了该人群特有的支架内再狭窄新危险因素，并提出了一种可能降低该风险的技术方法。
