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Restenosis seen more often after carotid stenting than endarterectomy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Following carotid artery stenting or carotid endarterectomy, rates of restenosis are about 2.5 times higher with stenting, according to French investigators reporting in the April issue of Stroke.

Dr. Jean-Louis Mas, with Hopital Sainte-Anne and Universite Paris Descartes, and colleagues note that carotid artery stenting (CAS) is being evaluated as an alternative to carotid artery endarterectomy (CEA) for patients with severe carotid artery stenosis.

The authors report results in 242 CAS patients and 265 CEA patients in the EVA-3S trial. “At 3 years, 27 patients with CAS had restenosis of (at least) 50% or occlusion compared to 12 patients with CEA, giving cumulative rates of 12.5% and 5.0%, respectively,”( p=0.02), the team found.

So far, rates of severe restenosis of at least 70% have been similar in both groups; cumulative 3-year rates are 3.3% with CAS vs. 2.8% with CEA.

Also, the data have not indicated that carotid restenosis is associated with risk of stroke. Over the 3 years, 4 (10.3%) of the patients with restenosis and 25 (5.3%) of those without restenosis had a stroke or TIA (p=0.27).

Dr. Mas and colleagues suggest that rates of severe restenosis after CAS may increase with time. “More data are needed to assess the rates of moderate and severe restenosis over time after CAS … to determine the relation between restenosis and recurrent stroke over time and to assess whether patients treated with endarterectomy or stenting require long-term follow-up with carotid ultrasound to detect restenosis,” they conclude.

Reference:

Restenosis Is More Frequent After Carotid Stenting Than After Endarterectomy

Am J Cardiol 2011.
Stroke 2011;42.