A full list of CAVATAS Investigators is provided at the end of the manuscript.
Length of carotid stenosis predicts peri-procedural stroke or death and restenosis in patients randomized to endovascular treatment or endarterectomy
Article first published online: 29 JUL 2013
© 2013 The Authors. International Journal of Stroke published by John Wiley & Sons Ltd on behalf of World Stroke Organization.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
International Journal of Stroke
Volume 9, Issue 3, pages 297–305, April 2014
How to Cite
Bonati, L. H., Ederle, J., Dobson, J., Engelter, S., Featherstone, R. L., Gaines, P. A., Beard, J. D., Venables, G. S., Markus, H. S., Clifton, A., Sandercock, P., Brown, M. M. and CAVATAS Investigators (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: 297–305. doi: 10.1111/ijs.12084
Conflict of interest: The authors declare no potential conflict of interest.
International randomized controlled trial number: ISRCTN 01425573.
Clinical Trial Registration: ISRCTN01425573, http://isrctn.org/
[The copyright line for this article was changed on 05 September 2014 after original online publication.]
- Issue published online: 17 MAR 2014
- Article first published online: 29 JUL 2013
- Manuscript Accepted: 10 DEC 2012
- Manuscript Received: 25 OCT 2012
- British Heart Foundation
- National Health Service Management Executive
- Stroke Association, UK
- carotid stenosis;
- endovascular treatment;
- plaque length
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.
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.
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.
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.