Author + information
- Anil Kumar K Jonnalagadda1,
- Pavlos Texakalidis2,
- Stefanos Giannopoulos3,
- Damianos G. Kokkinidis4,
- Ehrin J. Armstrong4,
- Theofilos Machinis5 and
- Jabbour M. Pascal6
- 1MedStar Washington Hospital Center, Washington, DC
- 2Division of Neurosurgery, Emory University, Atlanta, GA
- 3Division of Vascular Surgery, 251 Air Force Hospital of Athens, Athens, Greece
- 4Division of Cardiology, Denver VA Medical Center, University of Colorado, Denver, CO
- 5Division of Neurosurgery, Virgina Commonwealth University, Richmond, VA
- 6Department of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
Carotid artery restenosis may occur after ipsilateral carotid endarterectomy (CEA). It remains unclear whether carotid artery stenting (CAS) or a repeat CEA (redoCEA) is the best treatment strategy for carotid artery restenosis.
Materials & Methods
This study was performed according to the PRISMA and MOOSE guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 20, 2017. A meta-analysis was conducted with the use of random effects modeling. I-square was used to assess for heterogeneity.
Thirteen studies involving 4163 patients were included. Periprocedural (within 30 days) stroke, transient ischemic attack (TIA), myocardial infarction (MI), and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injuries was higher in the redoCEA group (OR: 9.84; 95% CI: 3.73 - 25.94; I2 =0%). CAS was associated with significantly lower risk for long-term recurrent carotid restenosis, when defined as stenosis >60% (OR: 2.15; 95% CI: 1.13 - 4.12; I2 =0%) or as stenosis >70% (OR: 2.31; 95% CI: 1.13 - 4.72; I2 =0%). No difference was identified in long-term target lesion revascularization rates between redoCEA and CAS.
Patients with carotid restenosis after CEA can safely undergo both CAS and CEA with similar risks of periprocedural stroke, TIA, MI and death. However, patients treated with CAS have a lower risk for a new restenosis and periprocedural CN injury.