Long-term outcome after angioplasty of symptomatic internal carotid artery stenosis with and without stent.

TY - JOUR

T1 - Long-term outcome after angioplasty of symptomatic internal carotid artery stenosis with and without stent.

AU - Wittkugel, Oliver

AU - Gbadamosi, Joystone

AU - Rosenkranz, Michael

AU - Fiehler, Jens

AU - Zeumer, Hermann

AU - Grzyska, Ulrich

PY - 2008

Y1 - 2008

N2 - INTRODUCTION: Carotid angioplasty and stenting (CAS) has widely replaced balloon angioplasty (percutaneous transluminal angioplasty, PTA) in the treatment of internal carotid artery stenosis (ICAS). Here we assess whether the use of stents increases the safety and long-term efficacy of angioplasty in patients with ICAS. Our aim was to test the hypothesis that the long-term efficacy of CAS is superior to that of PTA. METHODS: At the University Medical Center Hamburg-Eppendorf, PTA was performed from 1990 to 1997 and CAS was performed from 1998 to 2006. All patients undergoing these procedures were symptomatic. Selection and follow-up examinations were performed by independent vascular neurologists. Follow-up terms were 1, 3, 6 and 12 months, then annually. RESULTS: In the PTA group (n=71), 2.8% of the patients showed severe periinterventional complications (i.e. lasting neurological deficits). Of these 71 patients, 57.7% were followed up for an average period of 51 months. Stenosis >70% was observed in 9.8% of the PTA patients, while 4.9% of the patients had ipsilateral occlusions. In the CAS group (n=354), 4.2% of the patients showed severe periinterventional complications. In total, 61% of the CAS patients were followed up for an average period of 25 months, of whom 4.6% showed stenosis of >70% and 1.9% had ipsilateral occlusions. Periprocedural complications and new symptoms that appeared during follow-up occurred at a rate of 5.6% (PTA) and 5.9% (CAS). There was no difference in the rate of annual ipsilateral events (1.1% in PTA vs. 1.3% in CAS, p=1.000) CONCLUSION: Overall, the use of stents, rather than PTA only, shows no beneficial clinical effect in the treatment of ICA stenosis. While the rate of restenosis may be significantly reduced, this merely suggests that the impact of restenosis is less apparent than expected.

AB - INTRODUCTION: Carotid angioplasty and stenting (CAS) has widely replaced balloon angioplasty (percutaneous transluminal angioplasty, PTA) in the treatment of internal carotid artery stenosis (ICAS). Here we assess whether the use of stents increases the safety and long-term efficacy of angioplasty in patients with ICAS. Our aim was to test the hypothesis that the long-term efficacy of CAS is superior to that of PTA. METHODS: At the University Medical Center Hamburg-Eppendorf, PTA was performed from 1990 to 1997 and CAS was performed from 1998 to 2006. All patients undergoing these procedures were symptomatic. Selection and follow-up examinations were performed by independent vascular neurologists. Follow-up terms were 1, 3, 6 and 12 months, then annually. RESULTS: In the PTA group (n=71), 2.8% of the patients showed severe periinterventional complications (i.e. lasting neurological deficits). Of these 71 patients, 57.7% were followed up for an average period of 51 months. Stenosis >70% was observed in 9.8% of the PTA patients, while 4.9% of the patients had ipsilateral occlusions. In the CAS group (n=354), 4.2% of the patients showed severe periinterventional complications. In total, 61% of the CAS patients were followed up for an average period of 25 months, of whom 4.6% showed stenosis of >70% and 1.9% had ipsilateral occlusions. Periprocedural complications and new symptoms that appeared during follow-up occurred at a rate of 5.6% (PTA) and 5.9% (CAS). There was no difference in the rate of annual ipsilateral events (1.1% in PTA vs. 1.3% in CAS, p=1.000) CONCLUSION: Overall, the use of stents, rather than PTA only, shows no beneficial clinical effect in the treatment of ICA stenosis. While the rate of restenosis may be significantly reduced, this merely suggests that the impact of restenosis is less apparent than expected.

M3 - SCORING: Zeitschriftenaufsatz

VL - 50

SP - 243

EP - 249

JO - NEURORADIOLOGY

JF - NEURORADIOLOGY

SN - 0028-3940

IS - 3

M1 - 3

ER -