In Stent Restenosis Predictors after Carotid Artery Stenting

Abstract

Purpose. The long-term efficacy of carotid artery stenting is debated. Predictors of stent restenosis are not fully investigated. Our aim was to assess the incidence of long term restenosis after CAS and to identify some predictors of restenosis. Methods. We retrospectively selected 189 treated patients and we obtained the survival Kaplan-Meier curves for overall survival, for freedom from stroke or death and from restenosis. To correlate clinical, radiological, and procedural variables to stent restenosis, an univariate analysis was performed while to determine independent predictors of restenosis, a multivariate analysis was applied. Results. At 1, 3, and 5 years, the cumulative overall survival rate was 98%, 94%, and 92% with a cumulative primary patency rate of 87%, 82.5%, and 82.5%. The percentage residual stenosis after CAS and multiple stents deployment were independent predictors of restenosis, while diabetes and tumors are suggestive but not significant predictors of restenosis. Conclusions. In our CAS experience, encouraging long-term results seem to derive from both neurological event free rate and restenosis incidence. Adequate recanalization of the treated vessel is important to limit the development of stent restenosis. Multiple stents deployment, and with less evidence, diabetes, or neoplasms has to be considered to facilitate restenosis.

Diabetes is not a predictor of outcome for carotid revascularization with stenting as it may be for carotid endarterectomy

“…3,24 However, this hypothesis has not been supported by large evidence. Our study, as well as others in the literature, 2,25,26 confirmed that diabetic patients have similar restenosis rates compared with nondiabetic patients, whichever treatment was applied to treat carotid stenosis.…”

Predictors of restenosis after carotid artery stenting in 241 cases

“…This is consistent with previous studies that reported that restenosis is most common in the first year post CAS and the risk of restenosis decreases in subsequent years 8 9. Groschel et al 6 reported in their systematic review that 71% of patients had restenosis in the first year after CAS.…”

Wingspan Stents for the Treatment of Symptomatic Atherosclerotic Stenosis in Small Intracranial Vessels: Safety and Efficacy Evaluation

“…It is possible that the intramural wall stress from the stent caused more damage to the vessel wall and subsequent excessive repair, ultimately leading to ISR. 26 Therefore, choosing a stent of the appropriate size may effectively reduce the blood flow dynamics and mechanical interference on the vessel wall, thereby reducing the incidence of ISR.…”

“…They showed that patients with long lesions and a high percentage of residual stenosis have high rates of restenosis. 26,27 In our study, we divided 39 patients with imaging follow-up into 2 groups based on the median length of the vascular lesions (5.39 mm). Patients whose vascular lesions were longer than 5.39 mm had a much higher incidence of ISR (53% versus 15% for patients with a lesion length of 5.39 mm; P Ͻ .05).…”