Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Division of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
J Vasc Surg. 2021 Apr;73(4):1282-1289. doi: 10.1016/j.jvs.2020.07.102. Epub 2020 Aug 28.
The development of in-stent restenosis (ISR) hinders the long-term patency of carotid artery stenting (CAS), yet no optimal treatment has been established. In the present study, we compared the outcomes of redo CAS (rCAS) and carotid endarterectomy (CEA) for ISR.
A systematic search using the terms "in-stent restenosis," "carotid endarterectomy," and "carotid artery stenting" was conducted in the PubMed, Embase, and Cochrane databases. Studies reporting perioperative stroke, death, and other important complications of rCAS or CEA for ISR after previous CAS with four or more patients were included. Pooled and sensitivity analyses were conducted to synthesize and compare estimates of the outcomes.
A total of 11 studies with 1057 patients who had undergone rCAS (n = 894) or CEA (n = 163) met the inclusion criteria. The CEA group had a significantly greater proportion of symptomatic patients (rCAS vs CEA, 30.4% vs 42.1%; P < .01). The duration from primary CAS to reintervention was relatively longer in the CEA group (rCAS vs CEA, median, 8.8 months [range, 3-26 months] vs 19.9 months [range, 0-54 months]). In the rCAS group, a greater proportion of patients had hypertension, hypercholesterolemia, and coronary artery disease and had received antiplatelet therapy before reintervention. Because of insufficient data or a low incidence, the only complications feasible for further analysis were restenosis, myocardial infarction, cranial nerve injury, and neck hematoma. No significant differences were found in the primary end point of mortality/stroke event-free rate (rCAS vs CEA, 99% vs 98%; P > .05) or other secondary end points (event-free restenosis, 100% vs 100%; event-free myocardial infarction, 100% vs 98%; event-free cranial nerve injury, 100% vs 98%; event-free neck hematoma, 100% vs 100% for rCAS vs CEA; P > .05 for all).
rCAS is commonly used to treat patients with severe and/or symptomatic ISR after primary CAS. Although the endovascular approach is less invasive, both rCAS and CEA can be performed safely with similar short- and midterm outcomes of stroke, death, and surgery-related complications.
支架内再狭窄（ISR）的发展阻碍了颈动脉支架置入术（CAS）的长期通畅性，但尚未确立最佳治疗方法。本研究比较了再 CAS（rCAS）和颈动脉内膜切除术（CEA）治疗 ISR 的效果。
采用“in-stent restenosis”、“carotid endarterectomy”和“carotid artery stenting”等术语，在 PubMed、Embase 和 Cochrane 数据库中进行系统检索。纳入报道了先前接受过 4 次或更多次 CAS 治疗且有 4 例或更多例患者的 ISR 患者行 rCAS 或 CEA 治疗围手术期卒中、死亡和其他重要并发症的研究。进行了汇总分析和敏感性分析以综合比较结局的估计值。
共有 11 项研究纳入了 1057 例患者，这些患者接受了 rCAS（n=894）或 CEA（n=163）治疗。CEA 组中症状性患者的比例显著更高（rCAS 组 vs CEA 组，30.4% vs 42.1%；P<.01）。CEA 组从初次 CAS 到再干预的时间间隔相对较长（rCAS 组 vs CEA 组，中位数 8.8 个月[范围 3-26 个月] vs 19.9 个月[范围 0-54 个月]）。rCAS 组中，更多的患者有高血压、高胆固醇血症和冠心病，并在再次介入前接受了抗血小板治疗。由于数据不足或发生率较低，仅对进一步分析可行的并发症（再狭窄、心肌梗死、颅神经损伤和颈部血肿）进行了分析。死亡率/卒中事件无复发率的主要终点（rCAS 组 vs CEA 组，99% vs 98%；P>.05）或其他次要终点（无复发再狭窄，100% vs 100%；无复发心肌梗死，100% vs 98%；无复发颅神经损伤，100% vs 98%；无复发颈部血肿，rCAS 组 vs CEA 组均为 100%；所有比较的 P>.05）均无显著差异。
rCAS 常用于治疗初次 CAS 后严重和/或有症状的 ISR 患者。虽然血管内治疗方法的侵袭性较小，但 rCAS 和 CEA 均可安全进行，短期和中期的卒中、死亡和手术相关并发症发生率相似。
