Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

Abstract

<jats:p><jats:bold>Aim</jats:bold>. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.</jats:p><jats:p><jats:bold>Material and methods</jats:bold>. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.</jats:p><jats:p><jats:bold>Results</jats:bold>. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis &gt;50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age &gt;70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length &gt;15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis &lt;30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis &gt;&lt;30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length &gt;&lt; 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis &lt;30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).</jats:p><jats:p><jats:bold>Conclusion</jats:bold>. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length &gt;15 mm, and residual stenosis &lt; 30% may be associated with an increased risk of adverse events.</jats:p>