European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2026
Predictors of Restenosis After Carotid Endarterectomy and Carotid Artery Stenting: A Single Centre Retrospective Cohort Study.
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Geeraedts Anna J H, Kraai Tijmen W, Gareb Barzi, Röder Franziska, Kök Mert, Liesker David J, Saleem Ben R, Bokkers Reinoud P H, Uyttenboogaart Maarten, Zeebregts Clark J
Аннотация
OBJECTIVE: Restenosis after carotid revascularisation remains a clinical concern, yet predictors of restenosis after carotid endarterectomy (CEA) and carotid artery stenting (CAS) are still incompletely defined. This study aimed to identify clinical and procedural predictors of restenosis after CEA and CAS.
METHODS: This was a single centre retrospective cohort study. All patients who underwent primary CEA or CAS between January 2011 and December 2024 were included. The primary outcome was severe restenosis, (≥ 70% restenosis and/or re-intervention for restenosis > 30 days). The secondary outcome was any restenosis (≥ 50%). Multivariable Cox proportional hazards models were constructed to identify independent predictors, including separate analyses for CEA and CAS.
RESULTS: Included were 1 011 patients (744 CEA; 267 CAS), with mean follow up of 2.9 years. Severe restenosis occurred in 5.5% of patients, with similar rates after CEA and CAS. Any restenosis occurred in 10.3% (10.7% CEA vs. 9.0% CAS). In the overall cohort, women had a higher hazard of developing severe restenosis (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.03 - 3.02), whereas greater ipsilateral symptom severity at presentation was associated with a lower hazard of both severe (HR 0.73, 95% CI 0.55 - 0.95) and any restenosis (HR 0.67, 95% CI 0.55 - 0.82). CAS was associated with a lower hazard of any restenosis compared with CEA (HR 0.41, 95% CI 0.24 - 0.68). In procedure specific analyses, diabetes mellitus was significantly associated with any restenosis after CEA, while smoking was associated with restenosis after CAS at both thresholds.
CONCLUSION: Severe restenosis occurs in approximately 5% of patients following both CEA and CAS. Predictors differed by procedure: diabetes mellitus was associated with restenosis after CEA, whereas smoking after CAS. Higher ipsilateral symptom burden at presentation was consistently associated with a lower risk of restenosis. These findings provide insight into procedure specific risk profiles and may inform future risk stratified follow up studies.
METHODS: This was a single centre retrospective cohort study. All patients who underwent primary CEA or CAS between January 2011 and December 2024 were included. The primary outcome was severe restenosis, (≥ 70% restenosis and/or re-intervention for restenosis > 30 days). The secondary outcome was any restenosis (≥ 50%). Multivariable Cox proportional hazards models were constructed to identify independent predictors, including separate analyses for CEA and CAS.
RESULTS: Included were 1 011 patients (744 CEA; 267 CAS), with mean follow up of 2.9 years. Severe restenosis occurred in 5.5% of patients, with similar rates after CEA and CAS. Any restenosis occurred in 10.3% (10.7% CEA vs. 9.0% CAS). In the overall cohort, women had a higher hazard of developing severe restenosis (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.03 - 3.02), whereas greater ipsilateral symptom severity at presentation was associated with a lower hazard of both severe (HR 0.73, 95% CI 0.55 - 0.95) and any restenosis (HR 0.67, 95% CI 0.55 - 0.82). CAS was associated with a lower hazard of any restenosis compared with CEA (HR 0.41, 95% CI 0.24 - 0.68). In procedure specific analyses, diabetes mellitus was significantly associated with any restenosis after CEA, while smoking was associated with restenosis after CAS at both thresholds.
CONCLUSION: Severe restenosis occurs in approximately 5% of patients following both CEA and CAS. Predictors differed by procedure: diabetes mellitus was associated with restenosis after CEA, whereas smoking after CAS. Higher ipsilateral symptom burden at presentation was consistently associated with a lower risk of restenosis. These findings provide insight into procedure specific risk profiles and may inform future risk stratified follow up studies.