Department of Vascular Surgery, University of Florence, Italy.
Department of Vascular Surgery, University of Florence, Italy.
Eur J Vasc Endovasc Surg. 2018 Feb;55(2):153-161. doi: 10.1016/j.ejvs.2017.11.015. Epub 2017 Dec 26.
To compare results of open and endovascular management of post-carotid endarterectomy (CEA) restenosis.
This was a retrospective single centre matched case control study. From 2005 to 2015, 148 consecutive interventions for post-CEA restenosis were performed: 80 cases received carotid artery stenting (CAS) and 68 cases received redo CEA. Propensity score based matching was performed in a 1:1 ratio to compare outcomes. Coronary artery disease, degree of the carotid restenosis, timing of the re-intervention with respect to the primary intervention (greater or less than 24 months) and the presence of ipsilateral brain lesions were the covariates included in the matching. Peri-operative outcomes were analysed with χ tests, while late results were estimated by Kaplan-Meier methods.
After propensity matching, 32 CAS interventions were matched with 32 redo CEAs. There were no peri-operative deaths or strokes. Cranial nerve palsy occurred in seven patients in the redo CEA group. Median duration of follow-up was 36 months (interquartile range 24-60; range 6-120). The estimated 5 year survival rate was 94% in the CAS group and 72% in the redo CEA group (p=.1, log rank 2.4). There were no significant differences between the groups in terms of stroke free survival. In the CAS group, no severe restenosis were found, while in the redo CEA group eight patients had severe restenosis or occlusion of the operated carotid artery. Freedom from secondary restenosis at 4 years was 100% in the CAS group and 72.5% in the redo CEA group (p=.005, log rank 7.9). The corresponding figures in terms of freedom from secondary re-intervention were 100% and 83%, respectively (p=.02, log rank 4.8).
CAS and redo CEA in patients with post-CEA restenosis provided similar peri-operative results in a sample of equivalent patients. CAS patients had better follow-up results in terms of secondary restenosis and re-interventions. Further analysis is required with a larger number of patients and a longer follow-up time.
比较颈动脉内膜切除术（CEA）后再狭窄的开放和血管内治疗结果。
这是一项回顾性单中心匹配病例对照研究。2005 年至 2015 年，连续进行了 148 例 CEA 后再狭窄介入治疗：80 例接受颈动脉支架置入术（CAS），68 例接受再次 CEA。采用倾向评分匹配以 1:1 的比例比较结果。纳入匹配的协变量包括：冠心病、颈动脉再狭窄程度、再干预与原发干预的时间间隔（大于或小于 24 个月）和同侧脑病变。采用卡方检验分析围手术期结果，采用 Kaplan-Meier 方法估计晚期结果。
经倾向评分匹配后，32 例 CAS 干预与 32 例再次 CEA 匹配。无围手术期死亡或中风。再次 CEA 组 7 例患者出现颅神经麻痹。中位随访时间为 36 个月（四分位距 24-60；范围 6-120）。CAS 组的 5 年生存率为 94%，再次 CEA 组为 72%（p=.1，log rank 2.4）。两组之间在无中风生存率方面无显著差异。在 CAS 组，未发现严重再狭窄，而在再次 CEA 组，8 例患者发生了手术颈动脉的严重再狭窄或闭塞。4 年时，CAS 组的无二次再狭窄率为 100%，再次 CEA 组为 72.5%（p=.005，log rank 7.9）。在无二次再干预方面，相应的数字分别为 100%和 83%（p=.02，log rank 4.8）。
在相当的患者样本中，CEA 后再狭窄患者的 CAS 和再次 CEA 治疗的围手术期结果相似。CAS 患者在二次再狭窄和再干预方面的随访结果更好。需要进一步分析更多的患者和更长的随访时间。
