Restenosis After Carotid Angioplasty, Stenting, or Endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)
Open Access
- 1 February 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 36 (2), 281-286
- https://doi.org/10.1161/01.str.0000152333.75932.fe
Abstract
Background and Purpose— Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) patients with carotid stenosis were randomized between endovascular treatment and endarterectomy. The rates of residual severe stenosis and restenosis and their contribution to recurrent symptoms was unclear. Methods— Endovascular patients were treated by balloon angioplasty alone (88%) or stenting (22%). Patches were used in 63% of endarterectomy patients. Carotid stenosis was categorized as mild (0% to 49%), moderate (50% to 69%), severe (70% to 99%), or occluded, using standardized Doppler ultrasound criteria at the examination closest to 1 month (n=283) and 1 year (n=347) after treatment. Recurrent cerebrovascular symptoms during follow-up were analyzed. Results— More patients had ≥70% stenosis of the ipsilateral carotid artery 1 year after endovascular treatment than after endarterectomy (18.5% versus 5.2%, P =0.0001). Residual severe stenosis was present in 6.5% of patients at 1 month after endovascular treatment. Between 1 month and 1 year, restenosis to ≥70% stenosis occurred in 10.5% of the endovascular group. After endarterectomy, 1.7% had residual severe stenosis at 1 month, and 2.5% developed severe restenosis. The results were significantly better after stenting compared with angioplasty alone at 1 month ( P P =0.02), but most were transient ischemic attacks and none were disabling or fatal strokes. There were no recurrent symptoms in the 9 endarterectomy patients with ≥70% stenosis at 1 year. Conclusions— Carotid stenosis 1 year after endovascular treatment is partly explained by poor initial anatomical results and partly by restenosis. The majority of patients were treated by angioplasty without stenting. Further randomized studies are required to determine whether newer carotid stenting techniques are associated with a lower risk of restenosis. The low rate of recurrent stroke in both endovascular and endarterectomy patients suggests that treatment of restenosis should be limited to patients with recurrent symptoms, but long term follow up data are required.Keywords
This publication has 16 references indexed in Scilit:
- Carotid angioplasty and stentingBritish Medical Bulletin, 2000
- Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe StenosisNew England Journal of Medicine, 1998
- Clinical and Ultrasonic Long-Term Results of Percutaneous Transluminal Carotid AngioplastyCerebrovascular Diseases, 1998
- Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery TrialThe Lancet, 1996
- Angioplasty of the Internal Carotid Artery: Results, Complications and FoIlow-Up in 61 CasesCerebrovascular Diseases, 1996
- Coronary angioplasty versus coronary artery bypass surgery: the Randomised Intervention Treatment of Angina (RITA) trialThe Lancet, 1993
- Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanningJournal of Vascular Surgery, 1993
- Percutaneous Angioplasty of Atherosclerotic Carotid ArteriesCerebrovascular Diseases, 1991
- Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid StenosisNew England Journal of Medicine, 1991
- Does Carotid Restenosis Predict an Increased Risk of Late Symptoms, Stroke, or Death?Annals of Surgery, 1990