Drug‐Eluting Balloon Angioplasty for In‐Stent Restenosis Following Carotid Artery Stent Placement

Bhatia, Kunal; Akhtar, Imran; Akinci, Yasemin; Liaqat, Jahanzeb; Siddiq, Farhan; Gomez, Camilo R.; Qureshi, Adnan I

doi:10.1111/jon.12706

“…In addition, our study on carotid artery balloon injury in rats demonstrated that endothelial cell injury, oxidative stress, apoptosis, and proline-rich tyrosine kinase 2/mitochondrial calcium uniporter (PyK2/MCU) regulation of Ca 2+ balance were involved in the pathological process of restenosis after vascular injury ( 29 ), which indicated that many factors are involved in the pathogenesis of ISR. The reported incidence of ISR following CAS varies widely, from 3% to 20% ( 30 ), and in our study was 9.5% (28/296), which was consistent with the literature.…”

Section: Discussionsupporting

confidence: 93%

Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting

Liu¹,

Su²,

Zhang³

et al. 2023

Quant Imaging Med Surg

0

View full text Add to dashboard Cite

Background In-stent restenosis is a crucial problem after carotid artery stenting, but the exact predictors of in-stent restenosis remain unclear. We aimed to evaluate the effect of cerebral collateral circulation on in-stent restenosis after carotid artery stenting and to establish a clinical prediction model for in-stent restenosis. Methods This retrospective case-control study enrolled 296 patients with severe carotid artery stenosis of C1 segment (≥70%) who underwent stent therapy from June 2015 to December 2018. Based on follow-up data, the patients were divided into the in-stent restenosis and no in-stent restenosis groups. The collateral circulation of the brain was graded according to the criteria of the American Society for Interventional and Therapy Neuroradiology/Society for Interventional Radiology (ASITN/SIR). Clinical data were collected, such as age, sex, traditional vascular risk factors, blood cell count, high-sensitivity C-reactive protein, uric acid, stenosis degree before stenting and residual stenosis rate, and medication after stenting. Binary logistic regression analysis was performed to identify potential predictors of in-stent restenosis, and a clinical prediction model for in-stent restenosis after carotid artery stenting was established. Results Binary logistic regression analysis showed that poor collateral circulation was an independent predictor of in-stent restenosis (P=0.003). We also found that a 1% increase in residual stenosis rate was associated with a 9% increase in the risk of in-stent restenosis (P=0.02). Ischemic stroke history (P=0.03), family history of ischemic stroke (P<0.001), in-stent restenosis history (P<0.001), and nonstandard medication after stenting (P=0.04) were predictors of in-stent restenosis. The risk of in-stent restenosis was lowest when the residual stenosis rate was 12.5% after carotid artery stenting. Furthermore, we used some significant parameters to construct a binary logistic regression prediction model for in-stent restenosis after carotid artery stenting in the form of a nomogram. Conclusions Collateral circulation is an independent predictor of in-stent restenosis after successful carotid artery stenting, and the residual stenosis rate tends to be below 12.5% to reduce restenosis risk. The standard medication should be strictly carried out for patients after stenting to prevent in-stent restenosis.

show abstract

“…Relevant studies have pointed out that DCB treatment for DES-ISR patients can improve the degree of in-stent stenosis [ 13 , 14 ]. It has also been reported that CBA can reduce the incidence of repeated ISR and have less lumen loss than ordinary high-pressure balloon preconditioning [ 15 , 16 ]. DCB is a commonly used treatment for coronary artery diseases, which can treat stenosis or occlusive vascular diseases by carrying chemotherapy drugs to the surface of the diseased vessels.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis

Wu

¹

,

Yu

²

,

Tang

³

et al. 2022

Computational and Mathematical Methods in Medicine

3

0

1

View full text Add to dashboard Cite

Objective. To investigate the efficacy of drug-coated balloon (DCB) combined with cutting balloon angioplasty (CBA) in the treatment of drug-eluting stent in-stent restenosis (DES-ISR) and to construct a predictive model for the occurrence of DES-ISR. Methods.According to the criteria of diagnosis, inclusion, and exclusion, DES-ISR patients who were treated in the outpatient and inpatient departments of cardiovascular medicine of Second People’s Hospital of Guangdong Province from July 2021 to December 2021 were included. A total of 72 cases were planned to be enrolled, including 36 cases in the control group and 36 cases in the experimental group. The control group was treated with DCB, and the experimental group was combined with CBA. The treatment success rate, coronary angiography results before and after surgery, and the incidence of major adverse cardiovascular events during the follow-up period were compared between the two groups. Seventy-two DES-ISR patients were divided into ISR group and 59 non-ISR patients were divided into non-ISR group. The clinical data of the two groups were compared to analyze the risk factors affecting the occurrence of DES-ISR, and the prediction model was established. Results. The surgical success rate of the experimental group was 94.44% (34/36), which was higher than the 77.78% (28/36) of the control group ( P < 0.05 ). The minimum lumen diameter (MLD) of the experimental group 6 months after operation was greater than that of the control group, the late lumen loss (LL) and lumen stenosis rate were higher than those in the control group, and the incidence of major adverse cardiovascular events was lower than that in the control group ( P < 0.05 ). In the ISR group, the proportion of patients with abnormal BMI, smoking, hypertension, diabetes, and family history of coronary heart disease and multivessel coronary artery disease was higher than that in the non-ISR group, the degree of stenosis target lesion was higher than that in the non-ISR group, the diameter of target lesion and stent diameter were smaller than those in the non-ISR group, and the length of target lesion and stent length were longer than those in the non-ISR group; the number of stents was more than that in the non-ISR group ( P < 0.05 ). Combined hypertension, multiple coronary artery lesions, stenosis target lesion degree ≥85.05%, and target lesion length ≥36.88 mm were risk factors for DES-ISR, and target lesion diameter ≥3.15 mm and stent diameter ≥3.15 mm were protective factors ( P < 0.05 ). The prediction model of DES-ISR was obtained by multiple logistic regression analysis, P = 1 1 + e 2.281 + 3.321 X hypertension + 3.427 X umber of arterial lesions + 3.359 X stenosis target lesion degree − 3.143 X target lesion diameter + 0.650 X target lesion length − 10.159 X stent diameter . The Hosmer-Lemeshow test showed that Hosmer-Lemeshow χ 2 = 0.925, P =0.413; the ROC curve analysis showed that the AUC of the prediction model for the occurrence of DES-ISR was 0.924, the SE value was 0.022, and the 95% CI was 0.880-0.967. Conclusion. DCB combined with CBA has good clinical efficacy in the treatment of DES-ISR, which can reduce the rate of lumen stenosis and the incidence of adverse cardiovascular events. The prediction model established according to risk factors has high predictive value for the occurrence of DES-ISR.

show abstract

“…A DEB is an emerging effective technique for treating ISR 14. The balloon is coated with chemotherapeutic agents that prevent endothelial proliferation 14.…”

Section: Introductionmentioning

confidence: 99%

Prevention of in-stent restenosis with drug-eluting balloons in patients with postirradiated carotid stenosis accepting percutaneous angioplasty and stenting

Wu

¹

,

Lin

²

,

Chung

³

et al. 2023

J NeuroIntervent Surg

3

0

View full text Add to dashboard Cite

ObjectiveTo investigate the technical safety and outcome of in-stent restenosis (ISR) prevention with drug-eluting balloon (DEB) in patients with postirradiated carotid stenosis (PIRCS) undergoing percutaneous angioplasty and stenting (PTAS).MethodsBetween 2017 and 2021, we prospectively recruited patients with severe PIRCS for PTAS. They were randomly separated into two groups based on endovascular techniques performed with and without DEB. Preprocedural and early postprocedural (within 24 hours) MRI, short-term ultrasonography (6 months after PTAS), and long-term CT angiography (CTA)/MR angiography (MRA), 12 months after PTAS, were performed. Technical safety was evaluated based on periprocedural neurological complications and the number of recent embolic ischemic lesions (REIL) in the treated brain territory on diffusion-weighted imaging of early postprocedural MRI.ResultsSixty-six (30 with and 36 without DEB) subjects were enrolled, with one failure in techniques. For 65 patients in the DEB versus conventional groups, technical neurological symptoms within 1 month (1/29 (3.4%) vs 0/36; P=0.197) and REIL numbers within 24 hours (1.0±2.1 vs 1.3±1.5; P=0.592) after PTAS showed no differences. Peak systolic velocity (PSVs) on short-term ultrasonography was significantly higher in the conventional group (104.13±42.76 vs .81.95±31.35; P=0.023). The degree of in-stent stenosis (45.93±20.86 vs 26.58±8.75; P<0.001) was higher, and there were more subjects (n=8, 38.9% vs 1, 3.4%; P=0.029) with significant ISR (≥ 50%) in the conventional group than in the DEB group on long-term CTA/MRA.ConclusionsWe observed similar technical safety of carotid PTAS with and without DEBs. The number of cases of significant ISR were fewer and the degree of stenosis of ISR was less in primary DEB-PTAS of PIRCS than for conventional PTAS in the 12-month follow-up.

show abstract

Drug‐Eluting Balloon Angioplasty for In‐Stent Restenosis Following Carotid Artery Stent Placement

Cited by 13 publications

References 39 publications

Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting

Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting

Efficacy and Prediction Model Construction of Drug-Coated Balloon Combined with Cutting Balloon Angioplasty in the Treatment of Drug-Eluting Stent In-Stent Restenosis

Prevention of in-stent restenosis with drug-eluting balloons in patients with postirradiated carotid stenosis accepting percutaneous angioplasty and stenting

Contact Info

Product

Resources

About