{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T06:05:24Z","timestamp":1769925924136,"version":"3.49.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:00:00Z","timestamp":1644537600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"HRDOP","award":["EFOP-3.6.3-VEKOP-16-2017-00009 project (\u00c1kos B\u00e9rczi and Bal\u00e1zs Bence Ny\u00e1r\u00e1di)"],"award-info":[{"award-number":["EFOP-3.6.3-VEKOP-16-2017-00009 project (\u00c1kos B\u00e9rczi and Bal\u00e1zs Bence Ny\u00e1r\u00e1di)"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>We aimed to evaluate the long-term outcome of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in patients who underwent both procedures on different sides.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this single-center retrospective study (2001\u20132019), 117 patients (men, N = 78; median age at CEA, 64.4 [interquartile range {IQR}, 57.8\u201372.2] years; median age at CAS, 68.8 [IQR, 61.0\u201376.0] years) with \u226550% internal carotid artery stenosis who had CEA on one side and CAS on the other side were included. The risk of restenosis was estimated by treatment adjusted for patient and lesion characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Neurological symptoms were significantly more common (41.9% vs 16.2%, P&lt;0.001) and patients had a significantly shorter mean duration of smoking (30.2 [standard deviation {SD}, 22.2] years vs 31.8 [SD, 23.4] years, P&lt;0.001), hypertension (10.1 [SD, 9.8] years vs 13.4 [SD, 9.1] years, P&lt;0.001), hyperlipidemia (3.6 [SD, 6.6] years vs 5.0 [SD, 7.3] years, P = 0.001), and diabetes mellitus (3.9 [SD, 6.9] years vs 5.7 [SD, 8.9] years, P&lt;0.001) before CEA compared to those before CAS. While the prevalence of heavily calcified stenoses on the operated side (25.6% vs 6.8%, P&lt;0.001), the incidence of predominantly echogenic\/echogenic plaques (53.0% vs 70.1%, P = 0.011) and suprabulbar lesions (1.7% vs 22.2%, P&lt;0.001) on the stented side was significantly higher. Restenosis rates were 10.4% at 1 year, 22.3% at 5 years, and 33.7% at the end of the follow-up (at 11 years) for CEA, while these were 11.4%, 14.7%, and 17.2%, respectively, for CAS. Cox regression analysis revealed a significantly higher risk of restenosis (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.05\u20133.10; P = 0.030) for CEA compared to that for CAS. After adjusting for relevant confounding factors (smoking, hypertension, diabetes mellitus, calcification severity, plaque echogenicity, and lesion location), the estimate effect size materially did not change, although it did not remain statistically significant (HR, 1.85; 95% CI, 0.95\u20133.60; P = 0.070).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Intra-patient comparison of CEA and CAS in terms of restenosis tilts the balance toward CAS.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0262735","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T18:25:56Z","timestamp":1644603956000},"page":"e0262735","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Restenosis rates in patients with ipsilateral carotid endarterectomy and contralateral carotid artery stenting"],"prefix":"10.1371","volume":"17","author":[{"given":"Dat Tin","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6323-892X","authenticated-orcid":true,"given":"Boldizs\u00e1r","family":"Vok\u00f3","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bal\u00e1zs Bence","family":"Ny\u00e1r\u00e1di","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tam\u00e1s","family":"Munk\u00e1csi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1kos","family":"B\u00e9rczi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zolt\u00e1n","family":"Vok\u00f3","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2984-2642","authenticated-orcid":true,"given":"Edit","family":"D\u00f3sa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,2,11]]},"reference":[{"issue":"1","key":"pone.0262735.ref001","first-page":"172","article-title":"Vascular surgery in the United States: workforce issues. 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Towards Safer Carotid Artery Stenting: A Scoring System for Anatomic Suitability","volume":"40","author":"S Macdonald","year":"2009","journal-title":"Stroke"},{"issue":"4","key":"pone.0262735.ref005","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.jvs.2015.08.119","article-title":"Carotid Angiographic Characteristics in the CREST Trial Were Major Contributors to Periprocedural Stroke and Death Differences Between Carotid Artery Stenting and Carotid Endarterectomy","volume":"63","author":"WS Moore","year":"2016","journal-title":"J Vasc Surg"},{"issue":"9719","key":"pone.0262735.ref006","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0140-6736(10)60239-5","article-title":"Carotid Artery Stenting Compared With Endarterectomy in Patients With Symptomatic Carotid Stenosis (International Carotid Stenting Study): An Interim Analysis of a Randomised Controlled Trial.","volume":"375","author":"J 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Ciccone","year":"2017","journal-title":"Vascular"},{"key":"pone.0262735.ref022","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.avsg.2015.11.017","article-title":"Feasibility and Safety of Simultaneous Carotid Endarterectomy and Carotid Stenting for Bilateral Carotid Stenosis: A Single-Center Experience using a Hybrid Procedure.","volume":"33","author":"RW Xu","year":"2016","journal-title":"Ann Vasc Surg."},{"issue":"1","key":"pone.0262735.ref023","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1161\/01.STR.26.1.188","article-title":"Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the ad hoc Committee, American Heart Association.","volume":"26","author":"WS Moore","year":"1995","journal-title":"Stroke"},{"issue":"4 Suppl","key":"pone.0262735.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejvs.2008.11.006","article-title":"ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques","volume":"37","author":"CD Liapis","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"1","key":"pone.0262735.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejvs.2017.06.026","article-title":"European Society for Vascular Surgery Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease","volume":"55","author":"HH Eckstein","year":"2018","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"6","key":"pone.0262735.ref026","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1016\/j.jvs.2010.11.122","article-title":"Reporting standards for carotid interventions from the Society for Vascular Surgery","volume":"53","author":"CH Timaran","year":"2011","journal-title":"J Vasc Surg"},{"issue":"4","key":"pone.0262735.ref027","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/j.jvs.2004.01.028","article-title":"Standards of practice: carotid angioplasty and stenting","volume":"39","author":"K Ouriel","year":"2004","journal-title":"J Vasc Surg"},{"issue":"2","key":"pone.0262735.ref028","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jvs.2009.01.065","article-title":"Proposed duplex velocity criteria for carotid restenosis following carotid endarterectomy with patch closure","volume":"50","author":"AF AbuRahma","year":"2009","journal-title":"J Vasc Surg"},{"issue":"3","key":"pone.0262735.ref029","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1583\/04-1527.1","article-title":"Determining in-stent stenosis of carotid arteries by duplex ultrasound criteria.","volume":"12","author":"SF Stanziale","year":"2005","journal-title":"J Endovasc Ther"},{"issue":"8","key":"pone.0262735.ref030","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1007\/s00270-020-02522-5","article-title":"Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent 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Woodcock","year":"1999","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"pone.0262735.ref034","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/jdi.12242","article-title":"Ultrasound analysis of gray-scale median value of carotid plaques is a useful reference index for cerebro-cardiovascular events in patients with type 2 diabetes","volume":"6","author":"K Ariyoshi","year":"2015","journal-title":"J Diabetes Investig"},{"issue":"6","key":"pone.0262735.ref035","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1007\/s10554-020-01801-z","article-title":"Ultrasound risk marker variability in symptomatic carotid plaque: impact on risk reclassification and association with temporal variation pattern.","volume":"36","author":"I Stenudd","year":"2020","journal-title":"Int J Cardiovasc Imaging"},{"issue":"5","key":"pone.0262735.ref036","first-page":"619","article-title":"Single-center prospective, randomized analysis of conventional and eversion carotid 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