PT  - JOURNAL ARTICLE
AU  - Garcia-Pastor, A.
AU  - Gil-Núñez, A.
AU  - Ramirez-Moreno, J.M.
AU  - González-Nafría, N.
AU  - Tejada, J.
AU  - Moniche, F.
AU  - Portilla-Cuenca, J.C.
AU  - Martínez-Sánchez, P.
AU  - Fuentes, B.
AU  - Gamero-García, M.A.
AU  - de Leciñana, M.A.
AU  - Masjuan, J.
AU  - Verge, D.C.
AU  - Aladro, Y.
AU  - Parkhutik, V.
AU  - Lago, A.
AU  - de Arce-Borda, A.M.
AU  - Usero-Ruiz, M.
AU  - Delgado-Mederos, R.
AU  - Pampliega, A.
AU  - Ximenez-Carrillo, Á.
AU  - Bártulos-Iglesias, M.
AU  - Castro-Reyes, E.
AU - on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group
TI  - Endarterectomy, Stenting, or Medical Treatment for Symptomatic Carotid Near-Occlusion: Results from CAOS, a Multicenter Registry Study
AID  - 10.3174/ajnr.A7617
DP  - 2022 Sep 01
TA  - American Journal of Neuroradiology
PG  - 1304--1310
VI  - 43
IP  - 9
4099  - http://www.ajnr.org/content/43/9/1304.short
4100  - http://www.ajnr.org/content/43/9/1304.full
SO  - Am. J. Neuroradiol.2022 Sep 01; 43
AB  - BACKGROUND AND PURPOSE: The treatment of symptomatic carotid near-occlusion is controversial. Our aim was to analyze the results of carotid endarterectomy and carotid artery stent placement in patients with symptomatic carotid near-occlusion and to identify factors related to technical failure, periprocedural complications, and restenosis.MATERIALS AND METHODS: We conducted a multicenter, prospective nonrandomized study. Patients with angiography-confirmed carotid near-occlusion were included. We assessed the revascularization rate and periprocedural stroke or death. Twenty-four-month clinical and carotid imaging follow-up was performed, and rates of carotid restenosis or occlusion, ipsilateral stroke, and mortality were analyzed. Carotid artery stent placement, carotid endarterectomy, and medical treatment were compared.RESULTS: One hundred forty-one patients were included. Forty-four carotid artery stent placement and 23 carotid endarterectomy procedures were performed within 6 months after the event. Complete revascularization was achieved in 83.6%, 81.8% in the carotid artery stent placement group and 87% with carotid endarterectomy (P = .360). Periprocedural stroke or death occurred in 6% (carotid artery stent placement = 2.3%; carotid endarterectomy = 13%; P = .077) and was not related to revascularization failure. The carotid restenosis or occlusion rate was 8.3% (5% restenosis, 3.3% occlusion); with carotid artery stent placement it was 10.5%; and with carotid endarterectomy it was 4.5% (P = .419). The 24-month cumulative rate of ipsilateral stroke was 4.8% in the carotid artery stent placement group, 17.4% for carotid endarterectomy, and 13.1% for medical treatment (P = .223). Mortality was 12%, 4.5%, and 5.6%, respectively (P = .422). Revascularization failure and restenosis occurred more frequently in patients with full collapse compared with patients without full collapse (33.3% versus 5.6%, P = .009; 21.4% versus 2.9%, P = .032, respectively).CONCLUSIONS: Carotid artery stent placement and carotid endarterectomy are associated with high rates of failure and periprocedural stroke. Carotid near-occlusion with full collapse appears to be associated with an increased risk of technical failure and restenosis. Carotid near-occlusion revascularization does not seem to reduce the risk of stroke at follow-up compared with medical treatment.CAScarotid artery stent placementCEAcarotid endarterectomyCHScerebral hyperperfusion syndromeCNOcarotid near-occlusionIQRinterquartile range