Regarding “Patterns of in-stent restenosis after carotid artery stenting: Classification and implications for long term outcome”

Abstract Background In-stent restenosis (ISR) remains a potential problem and raises concerns about the long-term safety and efficacy of carotid artery stenting (CAS). As inflammation has a pivotal role in the pathogenesis of ISR, a novel and more sensitive inflammatory marker, CRP/albumin ratio (CAR) may be used to predict ISR in patients undergoing CAS. Purpose The present study aimed to assess the predictive value of preprocedural C-reactive protein/albumin ratio (CAR) for ISR after CAS. Method In this retrospective study, 206 patients who underwent successful CAS procedure in a tertiary heart centre were included. For each patient, both C-reactive protein (CRP) and serum albumin were determined before the index procedure. The CAR was calculated by dividing serum CRP by serum albumin level. The main end-point of the study was ISR during long-term follow-up. Results ISR developed in 34 (16.5%) out of 206 patients after a mean follow-up of 24.2±1.5 months. The CAR was significantly elevated in patients with ISR compared to those who were not (0.99 [1.3] vs. 0.15 [0.2], p<0.01, respectively). In a multivariate Cox regression analysis, the CAR was an independent predictor of ISR (HR: 1.85, 95% CI: 1.29–2.64, p<0.01). A ROC curve analysis revealed that the optimal value of CAR in predicting ISR was >0.53 with a sensitivity of 100% and a specificity of 97.1% [area under curve (AUC) 0.98, p<0.001]. Conclusion The present study demonstrated that CAR, a new inflammatory-based index, is a strong independent predictor of ISR after CAS. As a simple and easily accessible parameter, this index may be used for the assessment of ISR in patients who are treated with CAS. Funding Acknowledgement Type of funding source: None

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Long-term outcome and determinants of event-free survival in patients treated with balloon angioplasty for in-stent restenosis

The American Journal of Cardiology ◽

10.1016/s0002-9149(99)00071-5 ◽

1999 ◽

Vol 83 (8) ◽

pp. 1268-1270 ◽

Cited By ~ 30

Author(s):

Fernando Alfonso ◽

Marı́a J Pérez-Vizcayno ◽

Rosana Hernández ◽

Javier Goicolea ◽

Antonio Fernández-Ortı́z ◽

...

Keyword(s):

Balloon Angioplasty ◽

Event Free Survival ◽

Term Outcome ◽

Long Term Outcome ◽

Free Survival ◽

Stent Restenosis ◽

In Stent Restenosis

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

CardioVascular and Interventional Radiology ◽

10.1007/s00270-020-02522-5 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1134-1142

Author(s):

Miklós Vértes ◽

Dat T. Nguyen ◽

György Székely ◽

Ákos Bérczi ◽

Edit Dósa

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Common Carotid Artery ◽

Carotid Artery Stenting ◽

Stent Restenosis ◽

In Stent Restenosis

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Abstract WP28: Long-Term Outcome of Carotid Artery Stenting in Patients of Atherosclerotic Carotid Artery Disease : A 10-year Experience of a Single Tertiary Center in Korea

Stroke ◽

10.1161/str.44.suppl_1.awp28 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Chang-Hun Kim ◽

Wi-Sun Ryu ◽

Mi-Young Oh ◽

Seung-Hoon Lee ◽

Hyun-Seung Kang ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Asian Population ◽

Long Term Results ◽

Term Outcome ◽

Long Term Outcome ◽

Tertiary Center ◽

Artery Disease

Background & Objective Considering an increasing incidence of carotid artery disease in Asian subjects, the data showing long-term outcome of carotid artery stenting(CAS) from Asian population is mandatory. However, long-term outcome of CAS in Asian population have rarely been reported. The purpose of this study is to evaluate long-term results of CAS from the 10-year experience of a single center. Methods Patients undergoing CAS between May 2002 and May 2012 in our hospital were retrospectively reviewed. We abstracted demographic, clinical, and medical factors. In addition, plaque characteristics and angiographic factors were also evaluated. Neck CT angiography was followed-up every 6 months after CAS. We investigated the cumulative long-term incidence of carotid restenosis and risk factors for the development of restenosis. Results A total of 262 arteries (248 patients, mean age of 72.1±7.6 years, 81.7% male) were analysed. The degree of mean carotid stenosis was 70.9±17.5%. Symptomatic lesions were 178 (67.9%), and 84 (32.1%) arteries were asymptomatic. Predilatation (97.3%) and post-dilatation (42.4%) was performed during procedures. Embolic protection devices were used in 233 (88.9%) cases. During procedures, In-situ thrombosis with embolic infarction or TIA occurred in 6 (2.3%) and 10 (3.8%) cases, respectively. During a median follow-up time of 27.5 months, restenosis (> 50% stenosis) was detected in 18 (6.9%) of 262 arteries (asymptomatic, 16; symptomatic, 2). Restenotic lesions were treated in 6 (2.3%) cases with angioplasty including 2 symptomatic patients. The percentage of residual stenosis after stenting was significantly related to a risk of restenosis (p<0.02). Discussion Restenosis rate in this study was comparable to those of other single or multi-center trials in Western population. Our long-term results may validate CAS as a durable procedure for stroke prevention in patients with carotid artery stenosis in Korea.

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