Systematic review of early recurrent stenosis after carotid angioplasty and stenting

Background and Purpose - Carotid angioplasty and stenting (CAS) has emerged as a potential alternative to endarterectomy (CEA) for the treatment of carotid artery disease. Aside from the periprocedural complication rates, the benefits of CAS will be affected by the incidence of recurrent carotid stenosis. Methods - We conducted a systematic analysis of all peer-reviewed studies reporting on the rate of restenosis ( greater than or equal to 50%) after CAS based on duplex ultrasound or angiography that were published between January 1990 and July 2004. We identified 34 studies that reported on a total of 4185 patients with a follow-up of 3814 arteries over a median of 13 months ( range, 6 to 31 months). The ultrasound criteria and the lower thresholds for defining a recurrent stenosis were very heterogeneous. Results - The cumulative restenosis rates after 1 and 2 years were approximate to6% and 7.5% in those studies, which used a lower restenosis threshold greater than or equal to50% to 70% and approximate to4% in the first 2 years after CAS in those studies, which used a lower restenosis threshold > 70% to 80%. Conclusions - In reviewing the current literature, the early restenosis rates after CAS compare well with those reported for CEA. However, this analysis of the peer-reviewed literature also indicates that the early restenosis rates after CAS might be higher than previously suggested in observational surveys. Therefore, an active follow-up of all stented arteries seems to be warranted. Moreover, the bulk of endovascular data are derived from small studies with short follow-up periods so that the long-term durability of CAS still needs to be established in large trials. Ideally, these studies should use a clear and uniform definition of restenosis and identical follow-up schedules.