Advertisement

Carotid artery bypass versus endarterectomy as an alternative treatment of carotid artery stenosis: A propensity score matching analysis

      Abstract

      Objectives

      The main focus of this study is to evaluate the reliability and durability of saphenous vein bypass grafting from common carotid artery to internal carotid artery (CBG) asan alternative treatment of patients with carotid artery stenosis.

      Methods

      459 patients with carotid artery stenosis underwent initial carotid endarterectomy (CEA) or CBG between 2009 and 2019. Propensity score matching was performed, and outcomes of two different surgical procedures were analyzed.

      Results

      Outcomes of the 142 pairs of matched patients were investigated. There were no significant differences in the preoperative characteristics of these matched groups. Overall mean time of follow-up was 91.364 ± 3.265 months. Mortality rate during the follow-up period was 18.309% (26 patients) in the CEA group, and 11.971% (17 patients) in the CBG group. Stroke was encountered in 8 patients in the CEA group (5.63%), and 3 patients in the CBG group (2.11%) during follow-up. Restenosis was detected in 11 patients in the CEA group (7.75%), and 3 patients in the CBG group (3.52%) during follow-up. There were no significant differences in the survival, stroke – free survival, and restenosis - free survival distributions of both groups.

      Conclusions

      In carotid artery stenosis, it is reasonable to consider CBG as an alternative surgical option when adequate disease-free inflow (common carotid artery) and outflow (distal internal carotid artery) segments are present.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cheng SF
        • Brown MM
        • Simister RJ
        • Richards T.
        Contemporary prevalence of carotid stenosis in patients presenting with ischaemic stroke.
        Br J Surg. 2019; 106: 872-878https://doi.org/10.1002/bjs.11136
        • Lauder C
        • Kelly A
        • Thompson MM
        • London NJ
        • Bell PR
        • Naylor AR.
        Early and late outcome after carotid artery bypass grafting with saphenous vein [published correction appears in J Vasc Surg. 2004 Jan;39(1):188].
        J Vasc Surg. 2003; 38: 1025-1030https://doi.org/10.1016/s0741-5214(03)00418-x
        • Roddy SP
        • Darling 3rd, RC
        • Ozsvath KJ
        • et al.
        Choice of material for internal carotid artery bypass grafting: vein or prosthetic? Analysis of 44 procedures.
        Cardiovasc Surg. 2002; 10: 540-544https://doi.org/10.1016/s0967-2109(02)00075-3
        • Ramdon A
        • Martinez-Singh K
        • Hnath JC
        • Chang BB
        • Darling 3rd, RC
        Long-term patency of venous and prosthetic conduits for ipsilateral internal carotid artery bypass.
        J Vasc Surg. 2019; 70: 1935-1941https://doi.org/10.1016/j.jvs.2019.01.070
        • Huilgol RL
        • Young J
        • Lemech L
        • et al.
        Durability of autogenous vein and polytetrafluoroethylene bypass grafts to the carotid arteries.
        ANZ J Surg. 2006; 76: 878-881https://doi.org/10.1111/j.1445-2197.2006.03830.x
        • Dorafshar AH
        • Reil TD
        • Ahn SS
        • Quinones-Baldrich WJ
        • Moore WS.
        Interposition grafts for difficult carotid artery reconstruction: a 17-year experience.
        Ann Vasc Surg. 2008; 22: 63-69https://doi.org/10.1016/j.avsg.2007.07.038
        • Spinelli F
        • Martelli E
        • Stilo F
        • et al.
        Carotid bypass: a safe and durable solution for recurrent carotid stenosis.
        Ann Vasc Surg. 2014 Jul; 28: 1329-1334https://doi.org/10.1016/j.avsg.2013.12.031
        • Ricco JB
        • Marchand C
        • Neau JP
        • Marchand E
        • Cau J
        • Fébrer G
        Prosthetic carotid bypass grafts for atherosclerotic lesions: a prospective study of 198 consecutive cases.
        Eur J Vasc Endovasc Surg. 2009 Mar; 37: 272-278https://doi.org/10.1016/j.ejvs.2008.11.012
        • Branchereau A
        • Pietri P
        • Magnan PE
        • Rosset E
        Saphenous vein bypass: an alternative to internal carotid reconstruction.
        Eur J Vasc Endovasc Surg. 1996 Jul; 12 (10.1016/s1078-5884(96)80271-1): 26-30
        • Aboyans V
        • Ricco JB
        • Bartelink MEL
        • et al.
        ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS).
        Eur Heart J. 2018 Mar 1; 39 (PMID: 28886620): 763-816https://doi.org/10.1093/eurheartj/ehx095
        • Timaran CH
        • McKinsey JF
        • Schneider PA
        • Littooy F.
        Reporting standards for carotid interventions from the Society for Vascular Surgery.
        J Vasc Surg. 2011 Jun; 53: 1679-1695https://doi.org/10.1016/j.jvs.2010.11.122
        • Bonati LH
        • Gregson J
        • Dobson J
        • McCabe DJH
        • Nederkoorn PJ
        • van der Worp HB
        • de Borst GJ
        • Richards T
        • Cleveland T
        • Müller MD
        • Wolff T
        • Engelter ST
        • Lyrer PA
        • Brown MM
        International Carotid Stenting Study investigators. Restenosis and risk of stroke after stenting or endarterectomy for symptomatic carotid stenosis in the International Carotid Stenting Study (ICSS): secondary analysis of a randomised trial.
        Lancet Neurol. 2018 Jul; 17: 587-596https://doi.org/10.1016/S1474-4422(18)30195-9
        • AbuRahma AF
        • Stone P
        • Deem S
        • Dean LS
        • Keiffer T
        • Deem E.
        Proposed duplex velocity criteria for carotid restenosis following carotid endarterectomy with patch closure.
        J Vasc Surg. 2009 Aug; 50 (291.e1-2; discussion 291): 286-291https://doi.org/10.1016/j.jvs.2009.01.065
        • Naylor AR
        • Ricco JB
        • de Borst GJ
        • et al.
        Editor's Choice - 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: 3-81https://doi.org/10.1016/j.ejvs.2017.06.021
        • Columbo JA
        • Martinez-Camblor P
        • MacKenzie TA
        • et al.
        Comparing long-term mortality after carotid endarterectomy vs carotid stenting using a novel instrumental variable method for risk adjustment in observational time-to-event data.
        JAMA Netw Open. 2018 Sep 7; 1e181676https://doi.org/10.1001/jamanetworkopen.2018.1676
        • Brott TG
        • Howard G
        • Roubin GS
        • et al.
        Long-term results of stenting versus endarterectomy for carotid-artery stenosis.
        N Engl J Med. 2016 Mar 17; 374: 1021-1031https://doi.org/10.1056/NEJMoa1505215
        • Xin WQ
        • Li MQ
        • Li K
        • et al.
        Systematic and comprehensive comparison of incidence of restenosis between carotid endarterectomy and carotid artery stenting in patients with atherosclerotic carotid stenosis.
        World Neurosurg. 2019; 125: 74-86https://doi.org/10.1016/j.wneu.2019.01.118
        • Goodney PP
        • Nolan BW
        • Eldrup-Jorgensen J
        • Likosky DS
        • Cronenwett JL
        • Vascular Study Group of Northern New England
        Restenosis after carotid endarterectomy in a multicenter regional registry.
        J Vasc Surg. 2010; 52: 897-905https://doi.org/10.1016/j.jvs.2010.05.005