Restenosis after carotid angioplasty, stenting, or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)
Restenosis after carotid angioplasty, stenting, or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS)
复制标题
DOI：
10.1161/01.str.0000152333.75932.fe
复制
发表时间：
2005-02-01
期刊：
影响因子：
8.3
通讯作者：
Brown, MM
中科院分区：
文献类型：
--
作者：
McCabe, DJH;Pereira, AC;Brown, MM
背景和目的-颈动脉和椎动脉腔内血管成形术研究（CAVATAS）中，颈动脉狭窄的患者随机接受血管内治疗和动脉内膜切除术。残余的严重狭窄和再狭窄的比率和他们的贡献复发symptoms.Methods-Endovascular患者单独球囊血管成形术（88%）或支架（22%）治疗。63%的动脉内膜切除术患者使用了补片。在治疗后最接近1个月（n = 283）和1年（n = 347）的检查中，使用标准化多普勒超声标准将颈动脉狭窄分为轻度（0%至49%）、中度（50%至69%）、重度（70%至99%）或闭塞。结果血管内治疗后1年患侧颈动脉狭窄≥ 70%的患者多于动脉内膜切除术后的患者（18.5%对5.2%，P = 0.0001）。血管内治疗后1个月，6.5%的患者存在残余重度狭窄。在1个月至1年期间，血管内治疗组中10.5%的患者发生了≥ 70%狭窄的再狭窄。动脉内膜切除术后，1.7%在1个月时有残余重度狭窄，2.5%发生重度再狭窄。支架植入术后1个月时的结果明显优于单纯血管成形术（P < 0.001），但1年时无明显差异。与1年时狭窄程度较轻的患者（11/141 [7.8%]，P = 0.02）相比，1年时严重狭窄的血管内患者（5/32 [15.6%]）的同侧症状复发更常见，但大多数为短暂性脑缺血发作，无致残性或致死性卒中。9例动脉内膜切除术后狭窄>= 70%的患者在1 year. Conclusions颈动脉狭窄1年后血管内治疗的部分原因是最初的解剖结果不佳，部分原因是再狭窄。大多数患者接受了血管成形术治疗，未植入支架。需要进一步的随机研究来确定新的颈动脉支架植入技术是否与较低的再狭窄风险相关。血管内和动脉内膜切除术患者的卒中复发率较低，表明再狭窄治疗应仅限于症状复发的患者，但需要长期随访数据。
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 greater than or equal to70% 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 greater than or equal to70% 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 < 0.001) but not at 1 year. Recurrent ipsilateral symptoms were more common in endovascular patients with severe stenosis (5/32 [15.6%]) compared with lesser degrees of stenosis at 1 year (11/141 [7.8%], 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.