The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study.
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Carotid Stenosis
/ complications
Cerebral Angiography
Cerebral Revascularization
Endarterectomy, Carotid
Endpoint Determination
Female
Humans
Ischemic Attack, Transient
/ etiology
Male
Middle Aged
Neurosurgical Procedures
Prospective Studies
Registries
Spain
/ epidemiology
Stroke
/ epidemiology
carotid near-occlusion
carotid stenosis
recurrence
revascularization
risk
stroke
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
08
03
2019
accepted:
14
05
2019
pubmed:
28
5
2019
medline:
21
7
2020
entrez:
25
5
2019
Statut:
ppublish
Résumé
The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.
Sections du résumé
BACKGROUND AND PURPOSE
The risk of recurrent stroke amongst patients with symptomatic carotid near-occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24-month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO.
METHODS
A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography-confirmed SCNO were included. The primary end-point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted.
RESULTS
The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24-month cumulative incidence of the primary end-point was 11.1% (95% confidence interval 5.8-16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log-rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively.
CONCLUSIONS
The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near-occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure.
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1391-1398Informations de copyright
© European Academy of Neurology 2019.
Références
Fox AJ, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJM. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol 2005; 26: 2086-2094.
Rothwell PM, Eliasziw M, Gutnikov SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107-116.
Rothwell PM, Gutnikov SA, Warlow CP, ECSTC. Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 2003; 34: 514-523.
Johansson E, Öhman K, Wester P. Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 2015; 277: 615-623.
Radak DJ, Tanaskovic S, Ilijevski NS, et al. Eversion carotid endarterectomy versus best medical treatment in symptomatic patients with near total internal carotid occlusion: a prospective nonrandomized trial. Ann Vasc Surg 2010; 24: 185-189.
García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM, et al. Early risk of recurrent stroke in patients with symptomatic carotid near-occlusion: results from CAOS, a multicenter registry study. Int J Stroke 2017; 12: 713-719.
Meershoek AJA, Vries EE, Veen D, et al. Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion. Br J Surg 2019; 106: 665-671.
Naylor AR, Ricco J-B, de Borst GJ, et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 3-81.
Johansson E, Fox A. Carotid near-occlusion: a comprehensive review, part 1 - definition, terminology, and diagnosis. AJNR Am J Neuroradiol 2016; 37: 2-10.
Mylonas SN, Antonopoulos CN, Moulakakis KG, Kakisis JD, Liapis CD. Management of patients with internal carotid artery near total occlusion: an updated meta-analysis. Ann Vasc Surg 2015; 29: 1664-1672.
O'Leary D, Mattle H, Potter J. Atheromatous pseudo-occlusion of the internal carotid artery. Stroke 1989; 20: 1168-1173.
Akkan K, Ilgit E, Onal B, et al. Endovascular treatment for near occlusion of the internal carotid artery. Clin Neuroradiol 2018; 28: 245-252.
González A, Gil-Peralta A, Mayol A, et al. Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome. AJNR Am J Neuroradiol 2011; 32: 252-258.
Ruiz-Salmerón RJ, Gamero MA, Carrascosa C, et al. Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis. Neurologia 2013; 28: 535-542.
Kniemeyer HW, Aulich A, Schlachetzki F, Steinmetz H, Sandmann W. Pseudo- and segmental occlusion of the internal carotid artery: a new classification, surgical treatment and results. Eur J Vasc Endovasc Surg 1996; 12: 310-320.
Greiner C, Wassmann H, Palkovic S, Gauss C, Ferguson GG. Revascularization procedures in internal carotid artery pseudo-occlusion. Acta Neurochir (Wien) 2004; 146: 237-243.