THE EFFECTIVENESS OF INVASIVE THERAPY OF STENO-OCCLUSIVE LESIONS OF THE INTERNAL CAROTID ARTERY AND POPLITEAL ARTERY
Nguyen Tin Dat
Clinical Medicine
Dr. Reusz György
SE Városmajori Klinikák Tanterme
2024-09-06 15:00:00
ógia/atherosclerosis
Dr. Prohászka Zoltán
Dr. Dósa Edit
Dr. Doros Attila
Dr. Tóth Arnold
Dr. Székely Andrea
Dr. Korda Dávid
Dr. Szalontai László
The two main invasive therapeutic options for extracranial carotid artery stenosis are CEA and CAS, of which CEA remains the gold standard due to a lower rate of periprocedural neurological complications, but there is conflicting literature on long-term outcomes such as restenosis. Given the bilateral nature of ICA, it is possible to examine the rate of restenosis within the same patient (CEA on one side, CAS on the other). In our study, there was significantly more 70–90% restenosis after CEA than after CAS, especially in the later stages of follow-up; Cox regression analysis showed an HR of 1.80 in favor of CAS. The adjusted HR (1.85), which took into account smoking, hypertension, DM, calcification and echogenicity levels, lesion location, and treatment type, was barely different from the crude HR, supporting the importance of the duration of atherosclerotic risk factors.
There are many data on the short- and long-term success of CAS for extracranial ICA stenosis, but most studies have not analyzed lesions by location. We found a periprocedural neurological complication rate of 6.1% in patients who underwent CAS for isolated distal extracranial ICA stenosis. The primary patency rate was 97.2% at 6 months, 94.4% at 12 and 24 months, and 89.7% at 36 and 48 months in the atherosclerotic etiology group, and 100% during the entire follow-up period in the restenotic etiology group (P=0.528). The mortality rate at 48 months was relatively high (61.5%) in the group with restenotic etiology, however, this is probably not related to the stenting procedure itself, but to the more complex comorbidity profile of the restenotic population.
Peripheral artery disease usually involves multiple segments, which makes it difficult to assess the short- and mid-term success of endovascular interventions in a given arterial segment because of the inflow and outflow pathologies that influence treatment outcome. We aimed to investigate the success of PTA and/or stent implantation in truly isolated PA steno-occlusive disease. Primary patency rates were not significantly different (P=0.629) between the PTA and stenting groups. Restenosis was significantly less frequent (P=0.010) in patients with P1 stents than in patients with P2 plus multi-segment stents. Cox regression analysis identified the lesion location as a predictor of ISR (HR, 2.54).
