Impact of Diabetes Mellitus on Early Clinical Outcome and Stent Restenosis after Carotid Artery Stenting

Abstract

Background. Diabetes mellitus is closely related to both the severity of carotid disease and its outcome after revascularization. Carotid artery stenting (CAS) has emerged as a viable alternative to surgical endarterectomy but little is known about the impact of diabetes after CAS. Methods. A consecutive cohort of 1940 patients undergoing CAS in two institutions was divided into two groups, diabetics and nondiabetics, and major cerebrovascular events (MACCEs) were analyzed at 30 days post-CAS and at 1 year follow-up. Results. There were 730 patients with diabetes, with significantly higher BMI, hypertension, chronic dialysis, and dyslipidemia frequency ( p < 0.05 ). There was no significant difference between the two groups in terms of early and late MACCEs (composite of transient ischemic attack, major stroke, myocardial infarction, and death), with an early rate of 3.5% nondiabetics vs. 5.3%, p = 0.08 and 2.4 nondiabetics vs. 2.3% diabetics, p = 0.1 at 12 months. Overall stroke/death rate in the asymptomatic patients was 2.4%, and the restenosis rate was higher in the diabetes population (2.3% vs. 1%, p = 0.04 ). Conclusion. The presence of diabetes was associated with an acceptable increased periprocedural risk for CAS, but no further additional risk emerged during longer term follow-up. Diabetes may precipitate the rate of early in-stent restenosis.

Peripheral Arterial Disease in the Context of Acute Coronary Syndrome: A Comprehensive Analysis of Its Influence on Ejection Fraction Deterioration and the Onset of Acute Heart Failure

“…Moreover, they may encounter worse in-hospital outcomes, such as an increased death rate and heart failure [ 32 ]. This agrees with the results of the CRUSADE registry, in which PAD was an independent indicator of heart failure in NSTEMI patients [ 33 , 34 , 35 ].…”

Approaches to Peripheral Artery Disease in Diabetes: Are There Any Differences?

“…As a result, a patient with DM and PAD demonstrates a high-risk clinical profile that should be evaluated for comorbidities such as neuropathy, foot ulceration, or concurrent coronary artery disease, which could contribute to incapacity and disability [ 37 ]. A diabetic patient is polyarterial, meaning that the deleterious processes of glycosylation do not spare the coronary, carotid, or cerebral arteries [ 41 , 42 ].…”

An Overview of Specific Considerations in Chronic Venous Disease and Iliofemoral Venous Stenting

“…Although diabetes is a frequent comorbidity in patients with CVD, the exact correlation between the two is not yet known [ 43 ]. Similarly, unlike in the arterial system, where the presence of diabetes may accelerate the incidence of in-stent restenosis (ISR) [ 44 , 45 ], the effect of diabetes on ISR in venous stents is not clearly known.…”