Predictors of Restenosis Following Carotid Angioplasty and Stenting

Zapata-Arriaza, Elena; Moniche, Francisco; González, Alejandro; Bustamante, Alejandro; Escudero-Martínez, Irene; Laviana, Francisco Javier De la Torre; Prieto, M E; Mancha, Fernando; Montaner, Joan

doi:10.1161/strokeaha.116.012650

Cited by 37 publications

(13 citation statements)

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“…Gutierrez et al [21] reported female sex and diabetes as risk factors for recurrent carotid artery stenosis after endarterectomy. In addition, results from other studies have shown that contralateral stenosis, and ASA grades 2 and 3 are independent predictors of carotid restenosis [22,23]. Our results were not in link with previous studies.…”

Section: Discussioncontrasting

confidence: 86%

Risk Factors for Recurrent Carotid-Artery Stenosis Following Stenting Treatment

Meng¹,

Sun

2019

Med Sci Monit

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Background Carotid artery stenting (CAS) has been regarded as a reliable treatment approach for carotid artery stenosis. However, recurrent carotid artery stenosis after CAS affects long-term outcomes. In this study, we aimed to investigate the potential risk factors for carotid restenosis. Material/Methods We retrospectively analyzed the clinical data of patients diagnosed with carotid artery stenosis who underwent CAS implantation at our department from September 2012 to July 2015. Each included study patient was followed up with serial duplex ultrasound scanning. Kaplan-Meier estimates were used to evaluate freedom from restenosis and potential risk factors were analyzed. Results There were 33 patients enrolled in our study. The mean age was 65.5±11.5 years. The technique was successfully achieved in all patients. No death or major stroke occurred after stenting. There were 2 events of minor stroke and one myocardial infarction within 30 days after stent implantation. All the patients were followed up for 3 years. Cumulative rates of freedom from recurrent stenosis at 1, 2, and 3 years were 87.4%, 74.6%, and 68.3% respectively. Cox multivariate regression analysis revealed that male sex, smoking and hyperlipidemia were independent risk factors associated with restenosis. Conclusions In this study, we identified that CAS was a reliable approach for carotid artery stenosis. Male sex, smoking, and hyperlipidemia were independent risk factors associated with restenosis. Thus, hyperlipidemia should be monitored and routine follow-up with ultrasonography are recommended especially for male patients with current or history of smoking.

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Section: Discussioncontrasting

confidence: 86%

Risk Factors for Recurrent Carotid-Artery Stenosis Following Stenting Treatment

Meng¹,

Sun

2019

Med Sci Monit

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“…Duplex ultrasonography also correlated very well with catheter-based angiography. Peak systolic velocity (PSV) of 300 cm/s, enddiastolic velocity (EDV) of 140 cm/s, and ICA/CCA of 3.8 are, as well, optimal cutoff points to detect 70% restenosis after stenting (17,18).…”

Section: Discussionmentioning

confidence: 99%

Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

et al. 2020

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Background : The hybrid recanalization of internal carotid artery (ICA) and vertebral artery (VA) in-stent restenosis or occlusion using a combination of endarterectomy and endovascular intervention has achieved technical success. We present our surgical experiences to further evaluate the safety and efficacy of the hybrid technique for the treatment of in-stent restenosis and occlusion.Methods : A cohort of 12 refractory patients with in-stent restenosis or occlusion who underwent hybrid recanalization, a combination of endarterectomy and endovascular intervention, were retrospectively analyzed. Medical records, including presenting symptoms, comorbidities, contralateral ICA/VA findings, use of antiplatelet drugs, postoperative complications, and angiographic outcomes, were collected.Results : Among 415 consecutive patients with ICA, common carotid artery, and V1 segment lesions, 12 refractory patients (2.89%) with 13 cases were enrolled in our study (1 female and 11 male). All patients underwent successful hybrid recanalization. There were no cases of postoperative stroke or death. Only two patients sustained hoarseness, but it resolved within 2 weeks after surgery. Three patients were treated with dual antiplatelet (aspirin and clopidogrel), seven with single antiplatelet (aspirin), one with single antiplatelet (clopidogrel), and one with single antiplatelet (ticagrelor). All patients were followed up in the outpatient department according to the protocol, with a mean follow-up period of 13 months (range, 6–24 months). No death or recurrent symptoms occurred during the regular follow-up period.Conclusion : The hybrid technique maybe a safe and feasible treatment option to recanalize in-stent restenosis or occlusion with acceptable complications.

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“…Zapata-Arriaza et al . [ 40 ] reported that hypertension and impaired vasoreactivity were independent risk predictors of restenosis (≥70%), though their cohort included only angioplasty cases without stents. Regarding characteristics of the original plaque, plaques longer than 20 mm were reported to be significantly related to restenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent stenosis or in-stent restenosis after carotid artery stenting (CAS) is known as a risk factor of ipsilateral stroke, and this stroke risk should be monitored during patient follow-up. [ 22 23 24 ] Several factors related to post-CAS restenosis have been reported, including demography, comorbidity, and/or characters of original plaques, e.g., age,[ 4 22 ] female gender,[ 22 ] symptomatic cases,[ 13 ] diabetes,[ 5 22 ] hypertension,[ 22 40 ] hyperlipidemia,[ 22 ] inflammation markers,[ 37 ] high-degree stenosis,[ 32 ] and length of the plaques,[ 31 ] although some of these studies merely conducted univariate or combined analyses with restenoses after carotid endarterectomy (CEA). Several researchers reported CAS-procedure-related factors of post-CAS restenosis, such as immediate residual stenosis,[ 7 31 40 ] double stent deployment,[ 7 ] use of an open-cell stent,[ 20 ] and the predilation balloon diameter.…”

Section: Introductionmentioning

confidence: 99%

Calcification in original plaque and restenosis following carotid artery stenting

Katano¹,

Nishikawa²,

Yamada³

et al. 2017

Surg Neurol Int

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Background:The relationship between calcification in primary plaque and recurrent stenosis after carotid artery stenting (CAS) is not established, but an inverse association with restenosis following carotid endarterectomy (CEA) has been suggested.Methods:We retrospectively analyzed 75 plaques of 109 consecutive CAS with regard to calcification, using the calcium score and shape, location, and other characteristics of original plaques together with stenting-related factors. CAS was performed in a standard fashion with an embolic protection device. Greater-than-moderate restenosis (≥50%) was assessed by peak systolic velocity (PSV) with duplex ultrasonography (≥130 cm/s, internal/common carotid or distal/proximal PSV ratio ≥2.0).Results:Univariate analysis revealed percentages of dyslipidemia treated with statins (P = 0.03), calcification in distal ICA (P = 0.02), and immediate residual stenosis (P = 0.02) were significantly higher in patients with greater-than-moderate restenosis, whereas calcification in carotid bulb and usage of open-cell stent were rather less frequent (P < 0.001 and P = 0.02, respectively). Multivariate logistic regression analysis showed that rarity of calcification in carotid bulb was a sole independent predictor for greater-than-moderate recurrent carotid stenosis 1 year after CAS (OR = 0.21, CI = 0.06–0.77, P = 0.02).Conclusions:Calcium score was not significantly related to restenosis at 1 year after CAS, as was previously found following CEA, though scarcity of calcification in carotid bulb was suggested as a predictor of in-stent restenosis. Compared to post-CEA restenosis, carotid plaque calcification may be inversely but tenuously associated with recurrent stenosis 1 year post-CAS. No other stenting factors (e.g., stent design, pre-/post-dilation, or protection devices) showed a significant association with recurrent stenosis post-CAS.

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Predictors of Restenosis Following Carotid Angioplasty and Stenting

Cited by 37 publications

References 10 publications

Risk Factors for Recurrent Carotid-Artery Stenosis Following Stenting Treatment

Risk Factors for Recurrent Carotid-Artery Stenosis Following Stenting Treatment

Hybrid Recanalization for the Treatment of Carotid/Vertebral In-stent Restenosis or Occlusion: Pilot Surgery Experiences From One Single Center

Calcification in original plaque and restenosis following carotid artery stenting

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