Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent Restenosis

Abstract

Purpose In the absence of literature data, we aimed to determine the long-term patency rates of middle/distal common carotid artery (CCA) stenting and to investigate predisposing factors in the development of in-stent restenosis (ISR). Materials and Methods Fifty-one patients (30 males, median age 63.5 years), who underwent stenting with 51 self-expandable stents for significant (≥ 60%) stenosis of the middle/distal CCA, were analyzed retrospectively. Patient (atherosclerotic risk factors, comorbidities, medications), vessel (elongation), lesion (stenosis grade, length, calcification, location), and stent characteristics (material, diameter, length, fracture) were examined. Duplex ultrasonography was used to monitor stent patency. The Mann–Whitney U and Fisher’s exact tests, Kaplan–Meier analyses, and a log-rank test were used statistically. Results The median follow-up time was 35 months (interquartile range, 20–102 months). Significant (≥ 70%) ISR developed in 14 patients (27.5%; stenosis, N = 10; entire CCA occlusion, N = 4). Primary patency rates were 98%, 92%, 83%, 73%, and 61% at 6, 12, 24, 60, and 96 months, respectively. Reintervention was performed in six patients (11.8%) with nonocclusive ISR. Secondary patency rates were 100% at 6 and 12 months and 96% at 24, 60, and 96 months. In-stent restenosis developed more frequently ( P < .001) in patients with hyperlipidemia; primary patency rates were also significantly worse (Chi-square, 11.08; degrees of freedom, 1; P < .001) in patients with hyperlipidemia compared to those without. Conclusion Stenting of the middle/distal CCA can be performed with acceptable patency rates. If intervention is unequivocally needed, patients with hyperlipidemia will require closer follow-up care. Level of Evidence Level 3, Local non-random sample.

[Retracted] Predictive Value of Perioperative Cytokine Levels on the Risk for In‐Stent Restenosis in Acute Myocardial Infarction Patients

“…In-stent restenosis involves a series of complex pathophysiological processes. Smooth muscle proliferation, inflammation, and extracellular matrix accumulation are the main pathological mechanisms of in-stent restenosis [ 13 ]. The stent placement can mechanically damage the blood vessel wall, cause tearing of the vascular intima, force the subintimal matrix to release local inflammatory factors, activate the endogenous and exogenous coagulation system, and cause the pathological reaction of early stenosis during interventional surgery.…”

Genetic Variants in PHACTR1 & LPL Mediate Restenosis Risk in Coronary Artery Patients

“…Our results showing that dyslipidemia is a risk factor for restenosis are in line with other reports indicating that this risk is particularly increased in men. 12 High levels of oxidized LDL in the intima trigger the release of mitogens from platelets, macrophages, and endothelial cells. This process stimulates smooth muscle cell migration and proliferation which subsequently results in neointima formation.…”

“… 10 Despite the tremendous advances in the field, understanding the etiology of restenosis is incomplete. There are several risk factors for stenosis including: age, 11 dyslipidemia, 12 hypertension, 13 and history of restenosis 14 and these have been also frequently reported as clinical risk factors for restenosis. Of interest, diabetes mellitus 15 is one of the main risk factor for coronary artery restenosis considering its implications in a myriad of vasculopathies due to hyperglycemia-induced damaged endothelial function.…”

Amputation and mortality rates of patients undergoing upper or lower limb surgical embolectomy and their predictors

“…Demographic variables and risk factors for arterial disease included sex, age, smoking, hypertension, hyperlipidemia, and diabetes mellitus. The definition of each risk factor can be found in a publication by Vértes et al [ 16 ]. Patient’s history of cardiac and ischemic cerebral diseases, aneurysm, endovascular or open surgical repair, amputation, deep vein thrombosis (DVT), pulmonary embolism (PE), hypercoagulable state, chronic obstructive pulmonary disease (COPD), and malignancy was also collected.…”