Long-Term Results of Medical and Surgical Therapy for Japanese Patients With Moderate Carotid Stenosis

Stenotic lesion level did not affect outcomes of carotid endarterectomy

Background Carotid endarterectomy is the established treatment for carotid artery stenosis, and remains the primary surgical option due to its superior outcomes compared to carotid arterial stenting. However, Japanese patients are known to have unfavorable anatomical conditions for carotid endarterectomy, with a relatively higher level of the carotid artery bifurcation than in the Western population. We investigated the outcomes of carotid endarterectomy in our institute and evaluated the procedural quality by comparing patients based on higher or lower lesion levels. Methods The clinical data of 65 patients who underwent carotid endarterectomy were collected retrospectively. The outcomes reviewed included stroke-free survival and stroke-free rate. The patients were divided into a higher group ( n = 25) and a lower group ( n = 40), based on lesion location in respect of the 2nd cervical vertebral level. Results There was no perioperative death and only one case of stroke in the higher group within 30 days after carotid endarterectomy. At 5 years after carotid endarterectomy, the stroke-free survival rates were 83.4% in the higher group and 87.8% in the lower group, while the stroke-free rates were 96.0% and 94.0%, respectively; there were no significant differences between groups. Conclusions Stenotic lesion level did not affect the outcome or procedural quality of carotid endarterectomy.

Predictors of Restenosis After Carotid Endarterectomy

Introduction:

Carotid endarterectomy (CEA) is a well-established surgical technique in stroke prophylaxis. Long-term follow-up data on restenosis or recurrent neurological symptoms in Oriental patients are unclear.

Methods:

Patients’ notes from 1994 to 2011 were retrospectively reviewed and analyzed. A total of 301 cases of CEA were identified.

Results:

A lower restenosis rate was associated with the use of patch and never smokers in both univariate and multivariate analysis. Use of patch and never smokers were also found to be significantly associated with longer restenosis-free survival. Use of patch and postoperative use of statin were associated with better overall survival in both univariate and multivariate analysis.

Conclusion:

Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.

Surgical treatment for cervical carotid artery stenosis in the elderly: importance of perioperative management of ischemic cardiac complications

Ischemic cardiac complication is one of the major perioperative complications of surgical treatment for cervical carotid stenosis, carotid endarterectomy (CEA), and carotid artery stenting (CAS), and may greatly affect surgical outcome, especially in elderly patients aged ≥ 80 years. We retrospectively analyzed the records of 259 patients (34 patients aged ≥ 80 years) treated by CEA and 61 patients (12 patients aged ≥ 80 years) treated by CAS at Aizu Chuo Hospital from January 2000 to September 2010. Preoperative ischemic heart disease screening was performed in all patients. If high risk of coronary atherosclerotic stenosis was detected, treatment for coronary lesion was performed prior to CEA or CAS. There was no preoperative ischemic cardiac complication in both the CEA and CAS groups. Perioperative complications (morbidity + mortality) occurred in 2.9% of patients aged ≥ 80 years and 1.7% of patients aged ≤ 79 years in the CEA group, and 8.3% and 8.1% of patients, respectively, in the CAS group. There was no statistically significant difference by age in either group. CEA could be safely performed with tolerable complication rates even in elderly patients. However, the complication rate in the CAS group was relatively high. New ischemic lesion on diffusion-weighted magnetic resonance imaging, both symptomatic and asymptomatic, tended to occur at a higher rate in the CAS group, especially in the elderly patients. Thorough perioperative management may minimize ischemic cardiac complications even in elderly patients. Efforts must be continued to minimize surgical complications, especially for CAS. Noninvasive medical treatment should also be considered for elderly patients.