Comparison of carotid endarterectomy and repeated carotid angioplasty and stenting for in-stent restenosis(CERCAS trial):a randomised study

Background and aim In-stent restenosis(ISR)belongs to an infrequent but potentially serious complication after carotid angioplasty and stenting in patients with severe carotid stenosis.Some of these patients might be contraindicated to repeat percutaneous transluminal angioplasty with or without stenting(rePTA/S).The purpose of the study is to compare the safety and effectiveness of carotid endarterectomy with stent removal(CEASR)and rePTA/S in patients with carotid ISR.Methods Consecutive patients with carotid ISR(≥80%)were randomly allocated to the CEASR or rePTA/S group.The incidence of restenosis after intervention,stroke,transient ischaemic attack myocardial infarction and death 30 days and 1 year after intervention and restenosis 1 year after intervention between patients in CEASR and rePTA/S groups were statistically evaluated.Results A total of 31 patients were included in the study;14 patients(9 males;mean age 66.3±6.6 years)were allocated to CEASR and 17 patients(10 males;mean age 68.8±5.6 years)to the rePTA/S group.The implanted stent in carotid restenosis was successfully removed in all patients in the CEASR group.No clinical vascular event was recorded periproceduraly,30 days and 1 year after intervention in both groups.Only one patient in the CEASR group had asymptomatic occlusion of the intervened carotid artery within 30 days and one patient died in the rePTA/S group within 1 year after intervention.Restenosis after intervention was significantly greater in the rePTA/S group(mean 20.9%)than in the CEASR group(mean 0%,p=0.04),but all stenoses were<50%.Incidence of 1-year restenosis that was≥70%did not differ between the rePTA/S and CEASR groups(4 vs 1 patient;p=0.233).Conclusion CEASR seems to be effective and save procedures for patients with carotid ISR and might be considered as a treatment option.

Risk factors for carotid plaque progression after optimising the risk factor treatment: substudy results of the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the carotid Bifurcation Plaque Study (ANTIQUE)

Background and aim Carotid plaque progression contributes to increasing stroke risk.The study aims to identify factors influencing carotid plaque thickness progression after changing the preventive treatment to the‘treating arteries instead of risk factors’strategy,that is,change in treatment depending on the progression of atherosclerosis.Methods The study participants who completed sonographic controls over the course of 3 years were enrolled to the analysis.Duplex sonography of cervical arteries was performed in 6-month intervals with measurement of carotid plaque thickness.Plaque thickness measurement error(σ)was set as 3 SD.Only evidently stable and progressive plaques(defined as plaque thickness difference between initial and final measurements of˂σand>2σ,respectively)were included to analysis.Univariate and multivariate logistic regression analysis was performed to identify factors influencing plaque progression.Results A total of 1391 patients(466 males,age 67.2±9.2 years)were enrolled in the study.Progressive plaque in at least one carotid artery was detected in 255(18.3%)patients.Older age,male sex,greater plaque thickness,coronary heart disease,vascular surgery/stenting history and smoking were more frequently present in patients with progressive plaque(p˂0.05 in all cases).Multivariate logistic regression analysis identified only the plaque thickness(OR 1.850 for left side,95%CI 1.398 to 2.449;and OR 1.376 for right side,95%CI 1.070 to 1.770)as an independent factor influencing plaque progression.Conclusion Carotid plaque thickness corresponding to stenosis severity is the only independent risk factor for plaque thickness progression after optimising the prevention treatment.