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

Leo Bonati; Jorg Ederle; Joanna Dobson; Stefan Engelter; Roland Featherstone; Peter Gaines; Jonathan Beard; Graham Venables; Hugh Markus; Andrew Clifton; Peter Sandercock; Martin Brown; J Bland; Melita Brown; T Buckenham; A Clifton; Renay Taylor; Gloria Tognoni; Charles Warlow; T Bleakley; David Colquhoun; Lucy Coward; F Crawley; P Dobinson; S Holder; Dominick McCabe; Anthony Pereira; James Rogers; Louise Silver; Julie Burrett; John Crowther; M Dobson; B Hafner; John Heineman; Caroline Hope; Susan Knight; A Naughten; A Radley; Sarah Richards; Douglas Smith; S Wenzel; Michelle Harrison; Jose Ferro; Jane Beard; C Bladin; G Donnan; Gary Fell; Gregory Fitt; John Royle; Stephen Davis; Richard Gerraty; Peter Mitchell; Marcel Goodman; Graeme Hankey; Makhan Khangure; Michael Lawrence-Brown; Jennie Linto; William McAuliffe; F Prendergast; K Siennarine; Edward Stewart-Wynne; S Grahovac; William Morrish; N Pageau; C Pringle; D Richard; J Malms; Lutz Reiher; Mario Siebler; Giorgio Belloni; Mauro Porta; Angel Chamorro; Nicolas Vila; Vicente Riambau; Francisco Vazquez; Fernando Boza; J Garcia Rodriguez; Alberto Gil-Peralta; Alejandro Gonzalez; Jose Gonzalez-Marcos; Antonio Mayol Deya; J Rauno; Eberhard Kirsch; Phillippe Lyrer; J Rem; J Bogousslavsky; Antoine Uske; James Beard; Trevor Cleveland; Colin Doyle; Arul Sivaguru; P Leopold; Thomas Loosemore; Daniel McCabe; Andreia Pereira; Jane Rogers; Ronald Taylor; Thyge Enevoldson; G Gilling-Smith; Peter Harris; Thomas Nixon; Paul Baskerville; Thomas Cox; Simon Fraser; Melanie Jeffrey; Jane Molloy; Paul Butler; John Dick; F Frankel; Andrew Bradbury; Donald Collie; John Murie; Charles Ruckley; David Schultz; Robin Sellar; Joanna Wardlaw; Raymond Ashleigh; Charles McCollum; Paul O'Neill; Anil Gholkar; Alexander Mendelow; Timothy Walls; Heather Angus-Leppan; Shawn Halpin; Jocelyn Hughes; Ian Lane; Mark Wiles; Andrew Wood; Philip Birch; Jonathan Earnshaw; Geraint Fuller; Brian Heather; Keith Poskitt; A Tottle; Darren Hope; David Jefferson; Norman McConachie; Martin Duddy; M Heafield; R Vohra; R Collins

doi:10.1111/ijs.12084

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

Leo Bonati, Jorg Ederle, Joanna Dobson, Stefan Engelter, Roland Featherstone, Peter Gaines, Jonathan Beard, Graham Venables, Hugh Markus, Andrew Clifton, Peter Sandercock, Martin Brown, J Bland, Melita Brown, T Buckenham, A Clifton, Renay Taylor, Gloria Tognoni, Charles Warlow, T BleakleyDavid Colquhoun, Lucy Coward, F Crawley, P Dobinson, S Holder, Dominick McCabe, Anthony Pereira, James Rogers, Louise Silver, Julie Burrett, John Crowther, M Dobson, B Hafner, John Heineman, Caroline Hope, Susan Knight, A Naughten, A Radley, Sarah Richards, Douglas Smith, S Wenzel, Michelle Harrison, Jose Ferro, Jane Beard, C Bladin, G Donnan, Gary Fell, Gregory Fitt, John Royle, Stephen Davis, Richard Gerraty, Peter Mitchell, Marcel Goodman, Graeme Hankey, Makhan Khangure, Michael Lawrence-Brown, Jennie Linto, William McAuliffe, F Prendergast, K Siennarine, Edward Stewart-Wynne, S Grahovac, William Morrish, N Pageau, C Pringle, D Richard, J Malms, Lutz Reiher, Mario Siebler, Giorgio Belloni, Mauro Porta, Angel Chamorro, Nicolas Vila, Vicente Riambau, Francisco Vazquez, Fernando Boza, J Garcia Rodriguez, Alberto Gil-Peralta, Alejandro Gonzalez, Jose Gonzalez-Marcos, Antonio Mayol Deya, J Rauno, Eberhard Kirsch, Phillippe Lyrer, J Rem, J Bogousslavsky, Antoine Uske, James Beard, Trevor Cleveland, Colin Doyle, Arul Sivaguru, P Leopold, Thomas Loosemore, Daniel McCabe, Andreia Pereira, Jane Rogers, Ronald Taylor, Thyge Enevoldson, G Gilling-Smith, Peter Harris, Thomas Nixon, Paul Baskerville, Thomas Cox, Simon Fraser, Melanie Jeffrey, Jane Molloy, Paul Butler, John Dick, F Frankel, Andrew Bradbury, Donald Collie, John Murie, Charles Ruckley, David Schultz, Robin Sellar, Joanna Wardlaw, Raymond Ashleigh, Charles McCollum, Paul O'Neill, Anil Gholkar, Alexander Mendelow, Timothy Walls, Heather Angus-Leppan, Shawn Halpin, Jocelyn Hughes, Ian Lane, Mark Wiles, Andrew Wood, Philip Birch, Jonathan Earnshaw, Geraint Fuller, Brian Heather, Keith Poskitt, A Tottle, Darren Hope, David Jefferson, Norman McConachie, Martin Duddy, M Heafield, R Vohra, R Collins

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	297-305
Number of pages	9
Journal	International Journal of Stroke
Volume	9
Issue number	3
DOIs	https://doi.org/10.1111/ijs.12084
Publication status	Published - 1 Apr 2014

Keywords

Atherosclerosis
Carotid stenosis
Endarterectomy
Endovascular treatment
Plaque length
Restenosis

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10.1111/ijs.12084

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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., Taylor, R., Tognoni, G., Warlow, C., ... Collins, R. (2014). Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy. International Journal of Stroke, 9(3), 297-305. https://doi.org/10.1111/ijs.12084

@article{90c96c5b33d041a087abf67a45248da2,

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

abstract = "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.",

keywords = "Atherosclerosis, Carotid stenosis, Endarterectomy, Endovascular treatment, Plaque length, Restenosis",

author = "Leo Bonati and Jorg Ederle and Joanna Dobson and Stefan Engelter and Roland Featherstone and Peter Gaines and Jonathan Beard and Graham Venables and Hugh Markus and Andrew Clifton and Peter Sandercock and Martin Brown and J Bland and Melita Brown and T Buckenham and A Clifton and Renay Taylor and Gloria Tognoni and Charles Warlow and T Bleakley and David Colquhoun and Lucy Coward and F Crawley and P Dobinson and S Holder and Dominick McCabe and Anthony Pereira and James Rogers and Louise Silver and Julie Burrett and John Crowther and M Dobson and B Hafner and John Heineman and Caroline Hope and Susan Knight and A Naughten and A Radley and Sarah Richards and Douglas Smith and S Wenzel and Michelle Harrison and Jose Ferro and Jane Beard and C Bladin and G Donnan and Gary Fell and Gregory Fitt and John Royle and Stephen Davis and Richard Gerraty and Peter Mitchell and Marcel Goodman and Graeme Hankey and Makhan Khangure and Michael Lawrence-Brown and Jennie Linto and William McAuliffe and F Prendergast and K Siennarine and Edward Stewart-Wynne and S Grahovac and William Morrish and N Pageau and C Pringle and D Richard and J Malms and Lutz Reiher and Mario Siebler and Giorgio Belloni and Mauro Porta and Angel Chamorro and Nicolas Vila and Vicente Riambau and Francisco Vazquez and Fernando Boza and {Garcia Rodriguez}, J and Alberto Gil-Peralta and Alejandro Gonzalez and Jose Gonzalez-Marcos and {Mayol Deya}, Antonio and J Rauno and Eberhard Kirsch and Phillippe Lyrer and J Rem and J Bogousslavsky and Antoine Uske and James Beard and Trevor Cleveland and Colin Doyle and Arul Sivaguru and P Leopold and Thomas Loosemore and Daniel McCabe and Andreia Pereira and Jane Rogers and Ronald Taylor and Thyge Enevoldson and G Gilling-Smith and Peter Harris and Thomas Nixon and Paul Baskerville and Thomas Cox and Simon Fraser and Melanie Jeffrey and Jane Molloy and Paul Butler and John Dick and F Frankel and Andrew Bradbury and Donald Collie and John Murie and Charles Ruckley and David Schultz and Robin Sellar and Joanna Wardlaw and Raymond Ashleigh and Charles McCollum and Paul O'Neill and Anil Gholkar and Alexander Mendelow and Timothy Walls and Heather Angus-Leppan and Shawn Halpin and Jocelyn Hughes and Ian Lane and Mark Wiles and Andrew Wood and Philip Birch and Jonathan Earnshaw and Geraint Fuller and Brian Heather and Keith Poskitt and A Tottle and Darren Hope and David Jefferson and Norman McConachie and Martin Duddy and M Heafield and R Vohra and R Collins",

year = "2014",

month = apr,

day = "1",

doi = "10.1111/ijs.12084",

language = "English",

volume = "9",

pages = "297--305",

journal = "International Journal of Stroke",

issn = "1747-4949",

publisher = "Blackwell Publishing Ltd",

number = "3",

}

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, 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, Beard, 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, M, Linto, J, McAuliffe, W, Prendergast, F, Siennarine, K, Stewart-Wynne, E, Grahovac, S, Morrish, W, Pageau, N, 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 Rodriguez, J, Gil-Peralta, A, Gonzalez, A, Gonzalez-Marcos, J, Mayol Deya, A, Rauno, J, Kirsch, E, Lyrer, P, Rem, J, Bogousslavsky, J, Uske, A, Beard, J, Cleveland, T, Doyle, C, Sivaguru, A, 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, 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 & Collins, R 2014, 'Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy', International Journal of Stroke, vol. 9, no. 3, pp. 297-305. https://doi.org/10.1111/ijs.12084

TY - JOUR

T1 - Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy

AU - Bonati, Leo

AU - Ederle, Jorg

AU - Dobson, Joanna

AU - Engelter, Stefan

AU - Featherstone, Roland

AU - Gaines, Peter

AU - Beard, Jonathan

AU - Venables, Graham

AU - Markus, Hugh

AU - Clifton, Andrew

AU - Sandercock, Peter

AU - Brown, Martin

AU - Bland, J

AU - Brown, Melita

AU - Buckenham, T

AU - Clifton, A

AU - Taylor, Renay

AU - Tognoni, Gloria

AU - Warlow, Charles

AU - Bleakley, T

AU - Colquhoun, David

AU - Coward, Lucy

AU - Crawley, F

AU - Dobinson, P

AU - Holder, S

AU - McCabe, Dominick

AU - Pereira, Anthony

AU - Rogers, James

AU - Silver, Louise

AU - Burrett, Julie

AU - Crowther, John

AU - Dobson, M

AU - Hafner, B

AU - Heineman, John

AU - Hope, Caroline

AU - Knight, Susan

AU - Naughten, A

AU - Radley, A

AU - Richards, Sarah

AU - Smith, Douglas

AU - Wenzel, S

AU - Harrison, Michelle

AU - Ferro, Jose

AU - Beard, Jane

AU - Bladin, C

AU - Donnan, G

AU - Fell, Gary

AU - Fitt, Gregory

AU - Royle, John

AU - Davis, Stephen

AU - Gerraty, Richard

AU - Mitchell, Peter

AU - Goodman, Marcel

AU - Hankey, Graeme

AU - Khangure, Makhan

AU - Lawrence-Brown, Michael

AU - Linto, Jennie

AU - McAuliffe, William

AU - Prendergast, F

AU - Siennarine, K

AU - Stewart-Wynne, Edward

AU - Grahovac, S

AU - Morrish, William

AU - Pageau, N

AU - Pringle, C

AU - Richard, D

AU - Malms, J

AU - Reiher, Lutz

AU - Siebler, Mario

AU - Belloni, Giorgio

AU - Porta, Mauro

AU - Chamorro, Angel

AU - Vila, Nicolas

AU - Riambau, Vicente

AU - Vazquez, Francisco

AU - Boza, Fernando

AU - Garcia Rodriguez, J

AU - Gil-Peralta, Alberto

AU - Gonzalez, Alejandro

AU - Gonzalez-Marcos, Jose

AU - Mayol Deya, Antonio

AU - Rauno, J

AU - Kirsch, Eberhard

AU - Lyrer, Phillippe

AU - Rem, J

AU - Bogousslavsky, J

AU - Uske, Antoine

AU - Beard, James

AU - Cleveland, Trevor

AU - Doyle, Colin

AU - Sivaguru, Arul

AU - Leopold, P

AU - Loosemore, Thomas

AU - McCabe, Daniel

AU - Pereira, Andreia

AU - Rogers, Jane

AU - Taylor, Ronald

AU - Enevoldson, Thyge

AU - Gilling-Smith, G

AU - Harris, Peter

AU - Nixon, Thomas

AU - Baskerville, Paul

AU - Cox, Thomas

AU - Fraser, Simon

AU - Jeffrey, Melanie

AU - Molloy, Jane

AU - Butler, Paul

AU - Dick, John

AU - Frankel, F

AU - Bradbury, Andrew

AU - Collie, Donald

AU - Murie, John

AU - Ruckley, Charles

AU - Schultz, David

AU - Sellar, Robin

AU - Wardlaw, Joanna

AU - Ashleigh, Raymond

AU - McCollum, Charles

AU - O'Neill, Paul

AU - Gholkar, Anil

AU - Mendelow, Alexander

AU - Walls, Timothy

AU - Angus-Leppan, Heather

AU - Halpin, Shawn

AU - Hughes, Jocelyn

AU - Lane, Ian

AU - Wiles, Mark

AU - Wood, Andrew

AU - Birch, Philip

AU - Earnshaw, Jonathan

AU - Fuller, Geraint

AU - Heather, Brian

AU - Poskitt, Keith

AU - Tottle, A

AU - Hope, Darren

AU - Jefferson, David

AU - McConachie, Norman

AU - Duddy, Martin

AU - Heafield, M

AU - Vohra, R

AU - Collins, R

PY - 2014/4/1

Y1 - 2014/4/1

N2 - 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.

AB - 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.

KW - Atherosclerosis

KW - Carotid stenosis

KW - Endarterectomy

KW - Endovascular treatment

KW - Plaque length

KW - Restenosis

UR - http://www.scopus.com/inward/record.url?scp=84896317581&partnerID=8YFLogxK

U2 - 10.1111/ijs.12084

DO - 10.1111/ijs.12084

M3 - Article

SN - 1747-4949

VL - 9

SP - 297

EP - 305

JO - International Journal of Stroke

JF - International Journal of Stroke

IS - 3

ER -

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

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