Comarison of carotid artery stenting results in rimary stenosis and ost-surgical restenosis Andrea Sertino, MD Daniele Mascia, MD Vascular Surgery Vita-Salute University San Raffaele Scientific Institute, Milan Italy Chief: Prof. Roberto Chiesa
Disclosure Seaker name: Andrea Sertino, MD I have the following otential conflicts of interest to reort: Consulting Emloyment in industry Stockholder of a healthcare comany Owner of a healthcare comany Other(s) I do not have any otential conflict of interest 2
Carotid artery stenting (CAS) ESVS guidelines 1 ESVS 2009 Symtomatic > 70%, Grade I > 50%, Grade IIa Asymtomatic 70%, Grade I Evidence level A Carotid endarterectomy (CEA) is the gold standard CAS should be erformed only in high-risk for CEA atients 1. Liais CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009;37(4) Sul:1 19. doi: 10.1016/j.ejvs.2008.11.006. 3
Role of CAS in restenosis Addressed as intervention of choice 2,3 Several studies on CAS for rimary stenosis Lack of evidence on different outcome of CAS on restenosis treatment 4 2. Marques de Marino P, Martinez Loez I, Hernandez Mateo MM, et al. Oen Versus Endovascular Treatment for Patients with Post-Carotid Endarterectomy Restenosis: Early and Long-term Results. Ann Vasc Surg. 2016;36:159-165. doi:10.1016/j.avsg.2016.02.027 3. de Borst GJ, Ackerstaff RGA, de Vries JPPM, et al. Carotid angiolasty and stenting for ostendarterectomy stenosis: Long-term follow-u. J Vasc Surg. 2007;45(1):118-123. doi:10.1016/j.jvs.2006.09.013. 4. AbuRahma AF, Abu-Halimah S, Hass SM, et al. Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for atients with ost-carotid 4 endarterectomy stenosis. J Vasc Surg. 2010;52(5):1180-1187. doi:10.1016/j.jvs.2010.06.074.
Post-CEA restenosis 150.000 CEA are erformed every year in the USA 5 6% to 14% restenosis rate 15.000 restenosis in the USA every year 5.Kim LK, Yang DC et al. Comarison of trends and outcomes of carotid artery stenting and endarterectomy in the United States, 2001 to 2010. Circ Cardiovasc Interv. 2014;7:692 700. doi: 0.1161/CIRCINTERVENTIONS.113.001338. 5
Exerimental design Comarison of CAS in rimary stenosis and restenosis 1. Difference in atients characteristics 2. Intraoerative management 3. Postoerative results 6
Methods 480 atients submitted to CAS from 2008-2016 300 rimary stenosis 180 restenosis 7
Methods Preoerative data 6 (34 items) Demograhic CV risk factors Plaque characteristics Anatomy 6. Timaran CH, McKinsey JF, Schneider PA, Littooy F. Reorting standards for carotid interventions from the Society for Vascular Surgery. J Vasc Surg. 2011;53(6):1679-1695. doi:10.1016/j.jvs.2010.11.122. 8
Methods Intraoerative data (17 items) Drugs administration Surgical rocedure Materials used 9
Methods Postoerative data (14 items) TIA Minor stroke Major stroke Inotroic suort Myocardial infarction Death 10
Statistical analysis T student CHI square Variables Primary Stenosis (n = 300) Restenosis (n = 180) value Age (years) Age (years) 73,83 ± 8,93 73,83 ± 8,93 72,07 ± 7,18 72,07 ± 7,18 0,026 0,026 Gender M 224 (74,66%) 119 (66,11%) 0,044 Gender M 224 (74,66%) 119 (66,11%) 0,044 F 76 (25,34%) 61 (33,89%) F 76 (25,34%) 61 (33,89%) Systolic Systolic Pressure Pressure 135,63 135,63 ± 19,61 19,61 139,67 139,67 ± 18,33 18,33 0,025 0,025 (mmhg) (mmhg) Hyerliidemia Hyerliidemia 245 245 (81,66%) (81,66%) 165 165 (91,66%) (91,66%) 0,003 0,003 Cardiac Cardiac Status Status 141 141 (47%) (47%) 63 63 (35%) (35%) 0,010 0,010 Isilateral stenosis SPV 282,44 ± 84,58 337,43 337,43 ± 107,54 ± 107,54 < 0,001 T Student Test. Chi Square Test 11
Results Preoerative 100% 0.003 Primary Stenosis Restenosis 75% 50% 0.010 25% <0.001 <0.001 0.028 0% Hyerliidaemia Cardiac Disease Tye 3 laque Symtomatic Brain CT-scan 12
100% 0.272 0.035 Results Intraoerative Primary Carotid Stenosis Carotid Restenosis 75% 50% 0.052 <0.001 25% 0.023 0.847 0% Technical Success Carotid Filter 2 Stents Oen Cells Stents Double Layer Stents Atroine 13
Results Postoerative 10% Primary Carotid Stenosis 0.002 Carotid Restenosis 0.041 8% 5% 0.850 3% 0.276 0.620 0.714 0.714 0.881 0% Stroke TIA Cerebral haemorrhage Any Neurologic Event Arrhythmias Inotroic Suort IMA Death 14
Conclusions CAS for carotid ost-cea restenosis safe and effective rocedure lower risk of any neurological events (TIA+stroke) lower risk of erirocedural hemodinamic instability (inotroic suort) 15
Comarison of carotid artery stenting results in rimary stenosis and ost-surgical restenosis Andrea Sertino, MD Daniele Mascia, MD Vascular Surgery Vita-Salute University San Raffaele Scientific Institute, Milan Italy Chief: Prof. Roberto Chiesa