Outcomes of Carotid Artery Stenting in Near-Occlusion without Collapse: A Comparative Analysis with Severe Carotid Stenosis

Mehmet Cingoz; Mustafa Bal; Hamit Ozgul; Ali Dablan; Mustafa Fatih Arslan; Cagri Erdim; Oguzhan Turksayar; Tevfik Guzelbey

doi:10.58600/eurjther2650

Authors

Mehmet Cingoz Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0002-6937-2692
Mustafa Bal Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0009-0008-7411-1658
Hamit Ozgul Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0002-4117-191X
Ali Dablan Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0003-4198-4416
Mustafa Fatih Arslan Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0003-4361-5817
Cagri Erdim Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0002-2869-6842
Oguzhan Turksayar Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0009-0003-7617-6125
Tevfik Guzelbey Department of Radiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye https://orcid.org/0000-0001-5330-169X

DOI:

https://doi.org/10.58600/eurjther2650

Keywords:

balloon, angioplasty, internal carotid artery stenosis, digital subtraction angiography

Abstract

Objective: The current study aimed to compare the technical success, safety, and efficacy of carotid artery stenting (CAS) in patients with carotid near-occlusion without collapse with patients with severe carotid stenosis. The findings can provide insight into the clinical implications of treating near-occlusion without collapse as a distinct pathological entity.

Methods: A retrospective evaluation was conducted on 50 patients who had undergone CAS: 25 patients with carotid near-occlusion without collapse (Group 1) and 25 age- and sex-matched controls with severe carotid stenosis (≥70%) (Group 2). Diagnosis of near-occlusion was based on digital subtraction angiography findings, following established criteria, and all procedures were performed electively. Technical success, peri-procedural complications, and long-term outcomes were evaluated. The study focused on angiographic features, stent types, complications, and restenosis rates in the Group 1 patients.

Results: A comparable technical success rate (100%) was observed between the two study groups. In Group 1, periprocedural events were observed in three patients: two developed hypotension requiring adrenergic support, and one experienced bradycardia lasting 24 hours. In Group 2, two patients developed hypotension requiring medical treatment. Peri-procedural complications occurred in 8% and 12% of patients in Groups 1 and 2, respectively, with no significant difference (p=0.637). A median follow-up of 22.5 months in Group 1 and 28 months in Group 2 indicated symptomatic stroke rates of 4% in both groups, with no new symptomatic ischemic strokes observed beyond the peri-procedural period.

Conclusions: CAS in patients with near-occlusion without collapse demonstrated outcomes comparable to those with severe carotid stenosis, with similar rates of technical success, complications, and long-term efficacy.

Metrics

Metrics Loading ...

References

Fox AJ, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJ (2005) Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol 26:2086-2094.

Johansson E, Öhman K, Wester P (2015) Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 277:615-623. https://doi.org/10.1111/joim.12318

Johansson E, Fox AJ (2016) Carotid Near-Occlusion: A Comprehensive Review, Part 1--Definition, Terminology, and Diagnosis. AJNR Am J Neuroradiol 37:2-10. https://doi.org/10.3174/ajnr.A4432

Pulli R, Frosini P, Gatti M, Narcetti S, Bernacchi R, Pratesi C (1997) Internal carotid pseudo-occlusion: early and late results. J Cardiovasc Surg (Torino) 38:15-20.

Morgenstern LB, Fox AJ, Sharpe BL, Eliasziw M, Barnett HJ, Grotta JC (1997) The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Neurology 48:911-915. https://doi.org/10.1212/wnl.48.4.911

Rothwell PM, Gutnikov SA, Warlow CP (2003) Reanalysis of the final results of the European Carotid Surgery Trial. Stroke 34:514-523. https://doi.org/10.1161/01.str.0000054671.71777.c7

(1991) Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke 22:816-817. https://doi.org/10.1161/01.str.22.6.816

Rothwell PM, Warlow CP (2000) Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists' Collaborative Group. Stroke 31:622-630. https://doi.org/10.1161/01.str.31.3.622

O'Leary DH, Mattle H, Potter JE (1989) Atheromatous pseudo-occlusion of the internal carotid artery. Stroke 20:1168-1173. https://doi.org/10.1161/01.str.20.9.1168

Meershoek AJA, de Vries EE, Veen D, den Ruijter HM, de Borst GJ (2019) Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion. Br J Surg 106:665-671. https://doi.org/10.1002/bjs.11159

Abreu P, Nogueira J, Rodrigues FB, Nascimento A, Carvalho M, Marreiros A, Nzwalo H (2017) Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis. Acta Neurochir (Wien) 159:2089-2097. https://doi.org/10.1007/s00701-017-3328-4

Lippman HH, Sundt TM, Jr., Holman CB (1970) The poststenotic carotid slim sign: spurious internal carotid hypolasia. Mayo Clin Proc 45:762-767.

Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107-116. https://doi.org/10.1016/s0140-6736(03)12228-3

Aboyans V, Ricco JB, Bartelink MEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I, Document R, Widimsky P, Kolh P, Agewall S, Bueno H, Coca A, De Borst GJ, Delgado V, Dick F, Erol C, Ferrini M, Kakkos S, Katus HA, Knuuti J, Lindholt J, Mattle H, Pieniazek P, Piepoli MF, Scheinert D, Sievert H, Simpson I, Sulzenko J, Tamargo J, Tokgozoglu L, Torbicki A, Tsakountakis N, Tuñón J, Vega de Ceniga M, Windecker S, Zamorano JL (2018) Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 55:305-368. https://doi.org/10.1016/j.ejvs.2017.07.018

Ruiz-Salmerón RJ, Gamero MA, Carrascosa C, Pérez S, de Araujo D, Marcos F, Rodríguez de Leiras S, Vizcaíno M, Caparrós C, Izquierdo G (2013) Carotid artery stenting: clinical and procedural implications for near-occlusion stenosis. Neurologia 28:535-542. https://doi.org/10.1016/j.nrl.2013.01.001

Lieb M, Shah U, Hines GL (2012) Cerebral hyperperfusion syndrome after carotid intervention: a review. Cardiol Rev 20:84-89. https://doi.org/10.1097/CRD.0b013e318237eef8

Oka F, Ishihara H, Kato S, Oku T, Yamane A, Kunitugu I, Suzuki M (2013) Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion. J Vasc Surg 58:1512-1517. https://doi.org/10.1016/j.jvs.2013.05.103

Cay F, Cil BE, Balcı S, Arsava EM, Topçuoğlu MA, Arat A (2020) Relevance of Distal Arterial Collapse in Stenting of Atherosclerotic Near-Occlusion of the Carotid Artery. AJNR Am J Neuroradiol 41:1054-1060. https://doi.org/10.3174/ajnr.A6570

Kim J, Male S, Damania D, Jahromi BS, Tummala RP (2019) Comparison of Carotid Endarterectomy and Stenting for Symptomatic Internal Carotid Artery Near-Occlusion. AJNR Am J Neuroradiol 40:1207-1212. https://doi.org/10.3174/ajnr.A6085

Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, Moore WS, Hill MD, Mantese VA, Clark WM, Timaran CH, Heck D, Leimgruber PP, Sheffet AJ, Howard VJ, Chaturvedi S, Lal BK, Voeks JH, Hobson RW, 2nd (2016) Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. N Engl J Med 374:1021-1031. https://doi.org/10.1056/NEJMoa1505215