Abstract Number: Esoc2026a982 Restenosis Rates and Risk Factors After Carotid Artery Endarterectomy and Stenting

Abstract Background and aims Restenosis after carotid endarterectomy (CEA) and carotid artery stenting (CAS) remains a significant clinical concern. Understanding the relationship between clinical factors and the occurrence of long-term restenosis is essential. The aim of this single-centre retrospective observational study was to investigate long-term restenosis rates after CEA/CAS, and look for potential risk-factors. Methods Retrospectively we identified consecutive patients with CEA/CAS for symptomatic/asymptomatic carotid stenoses. Re-stenosis (≥70%) was identified in CTA/MRA reports or defined as ICA PSV exceeding 230cm/s. Multivariable Cox proportional hazards models were constructed adjusting for age, sex, vascular risk factors, symptomatic presentation, and hyperacute (concurrent with EVT) intervention , investigating the association of intervention type with restenosis at three month and last available follow-up. Results Between 2011 and 2024, 1785 carotids were identified (median age 73.1 years, 30.6% female, 76.1% symptomatic), 880 CEA (49.3%) and 905 CAS (50.7%). Mean/median follow-up was 1039/544 days (range 1-6058). At last available follow-up, rates between CEA and CAS were 6.8% and 7.2% respectively for restenosis, and 7.9% and 7.9% for stroke recurrence. Cox regression demonstrated no difference in restenosis risk between CAS and CEA (aHR 1.06, 95%CI 0.67-1.67). Hyperacute stenting showed an independent association (aHR 2.52, 1.34-4.75). Conclusions We demonstrate an increasing rate of carotid restenosis over the years after intervention, with no significant difference between CEA and CAS confirming the findings of RCTs in a large real-world study. There seemed to be an increased risk of restenosis for hyperacute stenting compared to subacute/elective. Conflict of interest No funding was requested for the conduction of this study. All authors do not have relevant conflicts of interest to disclose. Analysis is ongoing and final numbers may differ slightly due to ongoing adjudication of a small subset of outcomes. SP and SLW contributed equally to the research project.