Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.

BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Paclitaxel-Coated Balloon Angioplasty of Venous Stenoses in Native Dialysis Fistulas: Primary and Secondary Patencies at 6 and 12 Months.

PURPOSE: When dialysis access stenoses are dilated by noncoated balloons, respective primary and secondary patencies hardly reach 50 per cent and 85 per cent at one year. This study determines the primary and secondary patency rates at 6 and 12 months for venous stenoses treated by paclitaxel-coated balloon (PCB) angioplasty in native hemodialysis accesses. MATERIALS AND METHODS: From 2012 to 2014, 70 venous stenoses in 41 patients benefited from PCB angioplasties. The patients' mean age was 62.5 ± 13.8 years' standard deviation (SD) with 75 per cent male gender, 31.7 per cent diabetes, and 65.9 per cent arterial hypertension. There were 58.5 per cent forearm fistulas and 41.5 per cent arm fistulas. Primary and secondary patency rates were prospectively established by using the Kaplan-Meier technique and tested by using the log-rank test. RESULTS: The primary patency rates ± SD were 81.4 ± 4.6 per cent and 60 ± 5.9 per cent at 6 and 12 months, respectively. The secondary patency rates ± SD reached 94.3 ± 2.8 per cent at 6 months and 91.4 ± 3.3 per cent at 12 months. CONCLUSION: This study shows an improvement of the primary and secondary patency rates at 6 and 12 months when venous stenoses of native dialysis fistulas are treated by PCB. The indications for PCB, however, remain to be established by larger randomized studies.

[Stenting in superficial femoral artery and usCRP: Multicentric study SAFE in 255 patients]. / Stenting de l'artère fémorale superficielle et C-Reactive Protein ultrasensible (CRPus) : étude multicentrique SAFE de 255 patients.

OBJECTIVE: To evaluate mid-term primary patency of the femoral artery stenting in correlation with usCRP level and characteristics of the population, morphological aspect of the lesions and interventional techniques. METHODS: Patients were prospectively included in a multicenter study (18 centers in France) after stenting (SMART, Cordis Johnson & Johnson, Issy-les-Moulineaux, France) of the superficial femoral artery (SFA). Inclusion and exclusion criteria were based on recommendations and every day practice of the centers. RESULTS: Thus 255 patients (183 men; mean age: 69 years; range 44-92) were included. Technical success of the SFA stenting was 100% without any complications and primary angiographic success 97%. usCRP level increased significantly (p < 0.05) between before and 24h after SFA stenting. In the subgroup of patients without initial inflammation (n = 157), usCRP increased significantly (p < 0.05) in the group of patient with initial thrombosis and additional intervention (graft, amputation, angioplasty on other arterial bed) in the same procedure compared to the remaining patients. Restenosis rate was 12.4% (26/209 patients) at 7 ± 2 months. Before stenting, usCRP level was not predictive of a restenosis, whereas after stenting, an increase of the 24h usCRP level was significantly higher in the subgroup of patient with an occlusion at mid-term (8 patients; p < 0.05). CONCLUSION: This study demonstrated good patency at 7 months of SFA stenting with nitinol SMART with an increase of the usCRP level 24h after stenting in favour of the presence of an occlusion at mid-term follow-up.

Buttock claudication disclosing a thrombosis of the superior left gluteal artery: Report of a case diagnosed by a selective arteriography of the iliac artery, and cured by per-cutaneous stenting.

We report on a case of left buttock claudication, occurring consistently after 150 meters walking, and disappearing after a short rest. As magnetic resonance angiography (MRA) did not show any explanation for this claudication, a selective angiography of left internal iliac artery was requested, which clearly identified a tight stenosis of the onset of the left superior gluteal artery. A per-cutaneous angioplasty together with stenting of this artery, induced a prompt and complete relief of pain at the three months follow-up visit.