Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study
Á. García Pastor, Antonio Gil-Núñez, J.M. Ramírez-Moreno, Noelia González-Nafría, J. Tejada, Francisco Moniche, Juan Carlos Portilla-Cuenca, Patricia Martínez‐Sánchez, Blanca Fuentes, Miguel Ángel Gamero-García, María Alonso de Leciñana, Jaime Masjuán, D.C. Verge, Yolanda Aladro, Vera Parkhutik, Aída Lago, Ana de Arce, María Usero-Ruíz, Raquel Delgado‐Mederos, A. Pampliega, Álvaro Ximénez‐Carrillo, Mónica Bártulos-Iglesias, Enrique Castro-Reyes, on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group
Abstract
BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis. MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared. RESULTS: = .032, respectively). CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.