Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy

Background: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. Methods: In 414 patients with mostly symptomat...

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Main Authors:	Bonati, L., Ederle, J., Dobson, J., Engelter, S., Featherstone, R., Gaines, P., Beard, J., Venables, G., Markus, H., Clifton, A., Sandercock, P., Brown, M., Bland, J., Buckenham, T., Taylor, R., Tognoni, G., Warlow, C., Bleakley, T., Colquhoun, D., Coward, L., Crawley, F., Dobinson, P., Holder, S., McCabe, D., Pereira, A., Rogers, J., Silver, L., Burrett, J., Crowther, J., Dobson, M., Hafner, B., Heineman, J., Hope, C., Knight, S., Naughten, A., Radley, A., Richards, S., Smith, D., Wenzel, S., Harrison, M., Ferro, J., Bladin, C., Donnan, G., Fell, G., Fitt, G., Royle, J., Davis, S., Gerraty, R., Mitchell, P., Goodman, M., Hankey, G., Khangure, M., Lawrence-Brown, Michael, Linto, J., McAuliffe, W., Prendergast, F., Siennarine, K., Stewart-Wynne, E., Grahovac, S., Morrish, W., Pageau, N., E Pringle, C., Richard, D., Malms, J., Reiher, L., Siebler, M., Belloni, G., Porta, M., Chamorro, A., Vila, N., Riambau, V., Vazquez, F., Boza, F., Garcia Rodríguez, J., Gil Peralta, A., González, A., González Marcos, J., Mayol Deya, A., Rauno, J., Kirsch, E., Lyrer, P., Rem, J., Bogousslavsky, J., Uske, A., Cleveland, T., Doyle, C., Sivaguru, A., Leopold, P., Loosemore, T., Enevoldson, T., Gilling-Smith, G., Harris, P., Nixon, T., Baskerville, P., Cox, T., Fraser, S., Jeffrey, M., Molloy, J., Butler, P., Dick, J., Frankel, F., Bradbury, A., Collie, D., Murie, J., Ruckley, C., Schultz, D., Sellar, R., Wardlaw, J., Ashleigh, R., McCollum, C., O'Neill, P., Gholkar, A., Mendelow, A., Walls, T., Angus-Leppan, H., Halpin, S., Hughes, J., Lane, I., Wiles, M., Wood, A., Birch, P., Earnshaw, J., Fuller, G., Heather, B., Poskitt, K., Tottle, A., Hope, D., Jefferson, D., McConachie, N., Duddy, M., Heafield, M., Vohra, R.
Format:	Journal Article
Published:	Blackwell Publishing Ltd 2014
Online Access:	http://hdl.handle.net/20.500.11937/29233

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author	Bonati, L. Ederle, J. Dobson, J. Engelter, S. Featherstone, R. Gaines, P. Beard, J. Venables, G. Markus, H. Clifton, A. Sandercock, P. Brown, M. Bland, J. Brown, M. Buckenham, T. Clifton, A. Sandercock, P. Taylor, R. Tognoni, G. Warlow, C. Bleakley, T. Colquhoun, D. Coward, L. Crawley, F. Dobinson, P. Featherstone, R. Holder, S. Markus, H. McCabe, D. Pereira, A. Rogers, J. Silver, L. Burrett, J. Crowther, J. Dobson, M. Hafner, B. Heineman, J. Hope, C. Knight, S. Naughten, A. Radley, A. Richards, S. Smith, D. Wenzel, S. Harrison, M. Ferro, J. Beard, J. Buckenham, T. Brown, M. Clifton, A. Bladin, C. Donnan, G. Fell, G. Fitt, G. Royle, J. Davis, S. Gerraty, R. Mitchell, P. Goodman, M. Hankey, G. Khangure, M. Lawrence-Brown, Michael Linto, J. McAuliffe, W. Prendergast, F. Siennarine, K. Stewart-Wynne, E. Grahovac, S. Morrish, W. Pageau, N. E Pringle, C. Richard, D. Malms, J. Reiher, L. Siebler, M. Belloni, G. Porta, M. Chamorro, A. Vila, N. Riambau, V. Vazquez, F. Boza, F. Garcia Rodríguez, J. Gil Peralta, A. González, A. González Marcos, J. Mayol Deya, A. Rauno, J. Kirsch, E. Lyrer, P. Rem, J. Bogousslavsky, J. Uske, A. Beard, J. Cleveland, T. Doyle, C. Gaines, P. Sivaguru, A. Venables, G. Brown, M. Buckenham, T. Clifton, A. Colquhoun, D. Crawley, F. Leopold, P. Loosemore, T. McCabe, D. Pereira, A. Rogers, J. Taylor, R. Enevoldson, T. Gilling-Smith, G. Harris, P. Nixon, T. Baskerville, P. Cox, T. Fraser, S. Jeffrey, M. Markus, H. Molloy, J. Butler, P. Dick, J. Frankel, F. Bradbury, A. Collie, D. Murie, J. Ruckley, C. Sandercock, P. Schultz, D. Sellar, R. Wardlaw, J. Ashleigh, R. McCollum, C. O'Neill, P. Gholkar, A. Mendelow, A. Walls, T. Angus-Leppan, H. Halpin, S. Hughes, J. Lane, I. Wiles, M. Wood, A. Birch, P. Earnshaw, J. Fuller, G. Heather, B. Poskitt, K. Tottle, A. Hope, D. Jefferson, D. McConachie, N. Duddy, M. Heafield, M. Vohra, R.
author_facet	Bonati, L. Ederle, J. Dobson, J. Engelter, S. Featherstone, R. Gaines, P. Beard, J. Venables, G. Markus, H. Clifton, A. Sandercock, P. Brown, M. Bland, J. Brown, M. Buckenham, T. Clifton, A. Sandercock, P. Taylor, R. Tognoni, G. Warlow, C. Bleakley, T. Colquhoun, D. Coward, L. Crawley, F. Dobinson, P. Featherstone, R. Holder, S. Markus, H. McCabe, D. Pereira, A. Rogers, J. Silver, L. Burrett, J. Crowther, J. Dobson, M. Hafner, B. Heineman, J. Hope, C. Knight, S. Naughten, A. Radley, A. Richards, S. Smith, D. Wenzel, S. Harrison, M. Ferro, J. Beard, J. Buckenham, T. Brown, M. Clifton, A. Bladin, C. Donnan, G. Fell, G. Fitt, G. Royle, J. Davis, S. Gerraty, R. Mitchell, P. Goodman, M. Hankey, G. Khangure, M. Lawrence-Brown, Michael Linto, J. McAuliffe, W. Prendergast, F. Siennarine, K. Stewart-Wynne, E. Grahovac, S. Morrish, W. Pageau, N. E Pringle, C. Richard, D. Malms, J. Reiher, L. Siebler, M. Belloni, G. Porta, M. Chamorro, A. Vila, N. Riambau, V. Vazquez, F. Boza, F. Garcia Rodríguez, J. Gil Peralta, A. González, A. González Marcos, J. Mayol Deya, A. Rauno, J. Kirsch, E. Lyrer, P. Rem, J. Bogousslavsky, J. Uske, A. Beard, J. Cleveland, T. Doyle, C. Gaines, P. Sivaguru, A. Venables, G. Brown, M. Buckenham, T. Clifton, A. Colquhoun, D. Crawley, F. Leopold, P. Loosemore, T. McCabe, D. Pereira, A. Rogers, J. Taylor, R. Enevoldson, T. Gilling-Smith, G. Harris, P. Nixon, T. Baskerville, P. Cox, T. Fraser, S. Jeffrey, M. Markus, H. Molloy, J. Butler, P. Dick, J. Frankel, F. Bradbury, A. Collie, D. Murie, J. Ruckley, C. Sandercock, P. Schultz, D. Sellar, R. Wardlaw, J. Ashleigh, R. McCollum, C. O'Neill, P. Gholkar, A. Mendelow, A. Walls, T. Angus-Leppan, H. Halpin, S. Hughes, J. Lane, I. Wiles, M. Wood, A. Birch, P. Earnshaw, J. Fuller, G. Heather, B. Poskitt, K. Tottle, A. Hope, D. Jefferson, D. McConachie, N. Duddy, M. Heafield, M. Vohra, R.
author_sort	Bonati, L.
building	Curtin Institutional Repository
collection	Online Access
description	Background: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. Methods: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n=213) or carotid endarterectomy (n=211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis =50% during follow-up. Results: Carotid stenosis longer than 0·65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2·79 (1·17-6·65), P=0·02] and carotid endarterectomy [2·43 (1·03-5·73), P=0·04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1·68 (1·12-2·53), P=0·01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P=0·003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. Conclusions: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.
first_indexed	2025-11-14T08:13:34Z
format	Journal Article
id	curtin-20.500.11937-29233
institution	Curtin University Malaysia
institution_category	Local University
last_indexed	2025-11-14T08:13:34Z
publishDate	2014
publisher	Blackwell Publishing Ltd
recordtype	eprints
repository_type	Digital Repository
spelling	curtin-20.500.11937-292332018-03-29T09:08:12Z Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy Bonati, L. Ederle, J. Dobson, J. Engelter, S. Featherstone, R. Gaines, P. Beard, J. Venables, G. Markus, H. Clifton, A. Sandercock, P. Brown, M. Bland, J. Brown, M. Buckenham, T. Clifton, A. Sandercock, P. Taylor, R. Tognoni, G. Warlow, C. Bleakley, T. Colquhoun, D. Coward, L. Crawley, F. Dobinson, P. Featherstone, R. Holder, S. Markus, H. McCabe, D. Pereira, A. Rogers, J. Silver, L. Burrett, J. Crowther, J. Dobson, M. Hafner, B. Heineman, J. Hope, C. Knight, S. Naughten, A. Radley, A. Richards, S. Smith, D. Wenzel, S. Harrison, M. Ferro, J. Beard, J. Buckenham, T. Brown, M. Clifton, A. Bladin, C. Donnan, G. Fell, G. Fitt, G. Royle, J. Davis, S. Gerraty, R. Mitchell, P. Goodman, M. Hankey, G. Khangure, M. Lawrence-Brown, Michael Linto, J. McAuliffe, W. Prendergast, F. Siennarine, K. Stewart-Wynne, E. Grahovac, S. Morrish, W. Pageau, N. E Pringle, C. Richard, D. Malms, J. Reiher, L. Siebler, M. Belloni, G. Porta, M. Chamorro, A. Vila, N. Riambau, V. Vazquez, F. Boza, F. Garcia Rodríguez, J. Gil Peralta, A. González, A. González Marcos, J. Mayol Deya, A. Rauno, J. Kirsch, E. Lyrer, P. Rem, J. Bogousslavsky, J. Uske, A. Beard, J. Cleveland, T. Doyle, C. Gaines, P. Sivaguru, A. Venables, G. Brown, M. Buckenham, T. Clifton, A. Colquhoun, D. Crawley, F. Leopold, P. Loosemore, T. McCabe, D. Pereira, A. Rogers, J. Taylor, R. Enevoldson, T. Gilling-Smith, G. Harris, P. Nixon, T. Baskerville, P. Cox, T. Fraser, S. Jeffrey, M. Markus, H. Molloy, J. Butler, P. Dick, J. Frankel, F. Bradbury, A. Collie, D. Murie, J. Ruckley, C. Sandercock, P. Schultz, D. Sellar, R. Wardlaw, J. Ashleigh, R. McCollum, C. O'Neill, P. Gholkar, A. Mendelow, A. Walls, T. Angus-Leppan, H. Halpin, S. Hughes, J. Lane, I. Wiles, M. Wood, A. Birch, P. Earnshaw, J. Fuller, G. Heather, B. Poskitt, K. Tottle, A. Hope, D. Jefferson, D. McConachie, N. Duddy, M. Heafield, M. Vohra, R. Background: The anatomy of carotid stenosis may influence the outcome of endovascular treatment or carotid endarterectomy. Whether anatomy favors one treatment over the other in terms of safety or efficacy has not been investigated in randomized trials. Methods: In 414 patients with mostly symptomatic carotid stenosis randomized to endovascular treatment (angioplasty or stenting; n=213) or carotid endarterectomy (n=211) in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), the degree and length of stenosis and plaque surface irregularity were assessed on baseline intraarterial angiography. Outcome measures were stroke or death occurring between randomization and 30 days after treatment, and ipsilateral stroke and restenosis =50% during follow-up. Results: Carotid stenosis longer than 0·65 times the common carotid artery diameter was associated with increased risk of peri-procedural stroke or death after both endovascular treatment [odds ratio 2·79 (1·17-6·65), P=0·02] and carotid endarterectomy [2·43 (1·03-5·73), P=0·04], and with increased long-term risk of restenosis in endovascular treatment [hazard ratio 1·68 (1·12-2·53), P=0·01]. The excess in restenosis after endovascular treatment compared with carotid endarterectomy was significantly greater in patients with long stenosis than with short stenosis at baseline (interaction P=0·003). Results remained significant after multivariate adjustment. No associations were found for degree of stenosis and plaque surface. Conclusions: Increasing stenosis length is an independent risk factor for peri-procedural stroke or death in endovascular treatment and carotid endarterectomy, without favoring one treatment over the other. However, the excess restenosis rate after endovascular treatment compared with carotid endarterectomy increases with longer stenosis at baseline. Stenosis length merits further investigation in carotid revascularisation trials. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization. 2014 Journal Article http://hdl.handle.net/20.500.11937/29233 10.1111/ijs.12084 Blackwell Publishing Ltd restricted
spellingShingle	Bonati, L. Ederle, J. Dobson, J. Engelter, S. Featherstone, R. Gaines, P. Beard, J. Venables, G. Markus, H. Clifton, A. Sandercock, P. Brown, M. Bland, J. Brown, M. Buckenham, T. Clifton, A. Sandercock, P. Taylor, R. Tognoni, G. Warlow, C. Bleakley, T. Colquhoun, D. Coward, L. Crawley, F. Dobinson, P. Featherstone, R. Holder, S. Markus, H. McCabe, D. Pereira, A. Rogers, J. Silver, L. Burrett, J. Crowther, J. Dobson, M. Hafner, B. Heineman, J. Hope, C. Knight, S. Naughten, A. Radley, A. Richards, S. Smith, D. Wenzel, S. Harrison, M. Ferro, J. Beard, J. Buckenham, T. Brown, M. Clifton, A. Bladin, C. Donnan, G. Fell, G. Fitt, G. Royle, J. Davis, S. Gerraty, R. Mitchell, P. Goodman, M. Hankey, G. Khangure, M. Lawrence-Brown, Michael Linto, J. McAuliffe, W. Prendergast, F. Siennarine, K. Stewart-Wynne, E. Grahovac, S. Morrish, W. Pageau, N. E Pringle, C. Richard, D. Malms, J. Reiher, L. Siebler, M. Belloni, G. Porta, M. Chamorro, A. Vila, N. Riambau, V. Vazquez, F. Boza, F. Garcia Rodríguez, J. Gil Peralta, A. González, A. González Marcos, J. Mayol Deya, A. Rauno, J. Kirsch, E. Lyrer, P. Rem, J. Bogousslavsky, J. Uske, A. Beard, J. Cleveland, T. Doyle, C. Gaines, P. Sivaguru, A. Venables, G. Brown, M. Buckenham, T. Clifton, A. Colquhoun, D. Crawley, F. Leopold, P. Loosemore, T. McCabe, D. Pereira, A. Rogers, J. Taylor, R. Enevoldson, T. Gilling-Smith, G. Harris, P. Nixon, T. Baskerville, P. Cox, T. Fraser, S. Jeffrey, M. Markus, H. Molloy, J. Butler, P. Dick, J. Frankel, F. Bradbury, A. Collie, D. Murie, J. Ruckley, C. Sandercock, P. Schultz, D. Sellar, R. Wardlaw, J. Ashleigh, R. McCollum, C. O'Neill, P. Gholkar, A. Mendelow, A. Walls, T. Angus-Leppan, H. Halpin, S. Hughes, J. Lane, I. Wiles, M. Wood, A. Birch, P. Earnshaw, J. Fuller, G. Heather, B. Poskitt, K. Tottle, A. Hope, D. Jefferson, D. McConachie, N. Duddy, M. Heafield, M. Vohra, R. Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title	Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title_full	Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title_fullStr	Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title_full_unstemmed	Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title_short	Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
title_sort	length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
url	http://hdl.handle.net/20.500.11937/29233

Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy

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