The Incidence and Risk Factors of In-Stent Restenosis for Vertebrobasilar Artery Stenting

2018 ◽  
Vol 110 ◽  
pp. e937-e941 ◽  
Author(s):  
Dai Zheng ◽  
Zhu Mingyue ◽  
Shi Wei ◽  
Li Min ◽  
Chen Wanhong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stent Restenosis ◽  
Vertebrobasilar Artery ◽  
In Stent Restenosis

scholarly journals Collateral circulation is a predictor for in-stent restenosis after cerebral anterior circulation large artery stenting

2021 ◽  
Author(s):  
Luji Liu ◽  
Xudong Su ◽  
Zhongzhong Li ◽  
Kailin Bu ◽  
Si Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Therapy ◽  
Collateral Circulation ◽  
Large Artery ◽  
Anterior Circulation ◽  
Standard Drug ◽  
Residual Stenosis ◽  
Stent Restenosis ◽  
Stenosis Rate ◽  
In Stent Restenosis

Abstract Background- In-stent restenosis (ISR) is a critical issue of endovascular therapy. The predictors for ISR are not fully explored. We aimed to investigate the predictors for ISR, especially the effect of collateral circulation on ISR after cerebral large artery stenting. Methods- From June, 2015 to June, 2018, a total of 312 patients, who performed stenting, with severe cerebral anterior circulation stenosis (≥ 70%), were enrolled. According to the flow velocity indicated by carotid artery ultrasound or Transcranial Doppler, the patients were divided into the ISR and no-ISR groups. Clinical data were collected, including age, sex, cerebrovascular risk factors, preoperative serum lipid, inflammatory markers, and platelet count, stent site, residual stenosis rate, drug therapy after stenting. The collateral circulation was graded according to digital subtraction angiography (DSA). Univariable and multivariable logistic regression analyses were performed to assess the potential risk factors related to restenosis in such patients. Results- Higher residual stenosis rate (median 11% vs 10%, p = 0.040), fewer patients received standard drug therapy ( 73.3% vs 89.4%, p = 0.001), more patients with poor collateral circulation (70.0% vs 41.0%, p = 0.007) were found in ISR group. Residual stenosis rate increased by 10% was associated with a 19.1% increase in restenosis risk. Good collateral circulation (OR 0.16, [95%CI, 0.04–0.49]; p = 0.002) and receiving standard drug therapy (OR 0.14, [95%CI, 0.05–0.58]; p = 0.002) were significantly related to the lower risk of ISR. Conclusion- Collateral circulation is an independent factor related with ISR after successful cerebral anterior circulation large artery stenting, and long-term standard drug therapy after stenting should be strictly carried out in such patients.

The myth of restenosis after carotid angioplasty and stenting

2015 ◽  
Vol 8 (10) ◽  
pp. 1006-1010 ◽  
Author(s):  
Karam Moon ◽  
Felipe C Albuquerque ◽  
Michael R Levitt ◽  
Azam S Ahmed ◽  
M Yashar S Kalani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neck Surgery ◽  
Stent Restenosis ◽  
Atherosclerotic Lesions ◽  
Hostile Neck ◽  
History Of ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
In Stent Restenosis

Background and purposeReported rates of in-stent restenosis after carotid artery stenting (CAS) vary, and restenosis risk factors are poorly understood. We evaluated restenosis rates and risk factors, and compared patients with ‘hostile-neck’ carotids (a history of ipsilateral neck surgery or irradiation) and atherosclerotic lesions.MethodsDemographic, clinical, and radiological characteristics of patients undergoing cervical CAS between 1995 and 2010 with at least 1 month of follow-up were reviewed. Patients with substantial (≥50%) radiographic restenosis were compared with those without significant restenosis to identify restenosis risk factors.ResultsThe analysis included 121 patients with 133 stented vessels; 91 (68.4%) lesions were symptomatic. Indications for stent placement included hostile-neck lesions, substantial surgical comorbidities, inclusion in a randomized carotid stenting trial, acute carotid occlusion, tandem stenosis, large pseudoaneurysm, high carotid bifurcation, and contralateral laryngeal nerve palsy. Procedures were technically successful in all but one lesion (99.2%). Perioperative stroke occurred in four cases (3.0%). Mean follow-up was 38 months (range 1–204 months), during which 23 vessels (17.3%) developed restenosis. Hostile-neck carotids (n=57) comprised 42.9% of all vessels treated and were responsible for 15 of 23 restenosis cases, resulting in a significantly higher restenosis rate than that of primary atherosclerotic lesions (26.3% vs 10.5%, p=0.017). By univariate analysis, the presence of calcified plaque was significantly associated with the incidence of in-stent restenosis (p=0.02).ConclusionsRestenosis rates after carotid angioplasty and stenting are low. Patients with a history of ipsilateral neck surgery or irradiation are at higher risk for substantial radiographic and symptomatic restenosis.

Pre-procedural color duplex ultrasound evaluation predicts restenosis after long-segment superficial femoral artery stenting

Vascular ◽  
2021 ◽  
pp. 170853812199259
Author(s):  
Mingjie Gao ◽  
Yang Hua ◽  
Lingyun Jia ◽  
Xinyu Zhao ◽  
Ran Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Duplex Ultrasound ◽  
Hazard Ratio ◽  
Lesion Length ◽  
Stent Restenosis ◽  
Ultrasound Evaluation ◽  
Color Duplex Ultrasound ◽  
In Stent Restenosis

Objectives Restenosis after stenting for superficial femoral artery atherosclerotic disease remains a significant clinical problem, especially for long-segment lesions. We assessed predictors of in-stent restenosis in patients with long-segment superficial femoral artery disease and hypothesized that pre-procedural ultrasound assessment would predict in-stent restenosis. Methods This single-center study retrospectively analyzed 283 limbs in 243 patients who treated with superficial femoral artery nitinol stent placement for long-segment (≥15 cm) lesions between 2015 and 2018. Color duplex ultrasound was performed pre-procedure and post-procedure at 3, 6, 12, 24, and 36 months. The endpoint was ≥50% in-stent restenosis in the superficial femoral artery. Primary patency rates were analyzed with Kaplan–Meier survival analysis and compared using the log-rank test. A multivariable Cox proportional hazards model was used to evaluate the risk factors for in-stent restenosis. Results The median length of lesions was 25.8 ± 8.1 cm. The cumulative freedom from ≥50% in-stent restenosis at 3, 6, 12, 24, and 36 months was 95.3%, 78.3%, 56.0%, 30.6%, and 15.9%, respectively. Univariate and multivariate Cox regression analysis showed that cumulative lesion length ≥ 25 cm (hazard ratio 1.681; p =  0.003), calcified plaque (hazard ratio 1.549, p =  0.006), poor runoff scores >10 (hazard ratio 1.870, p =  0.003), and chronic renal failure (hazard ratio 2.075, p =  0.009) were independent risk factors for in-stent restenosis. The agreement rate between ultrasound and angiography was 92.6% for cumulative lesion length ( κ 0.851) and 91.9% for runoff score ( κ 0.872). Conclusions The results indicate that pre-procedural color duplex ultrasound evaluation is helpful for the selection of appropriate candidates for superficial femoral artery stent placement. Cumulative lesion length ≥25 cm, plaque calcification, poor distal runoff, and chronic renal failure independently predicted in-stent restenosis.

scholarly journals Long-Term Risk Factors for Intracranial In-Stent Restenosis From a Multicenter Trial of Stenting for Symptomatic Intracranial Artery Stenosis Registry in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Xu Guo ◽  
Ning Ma ◽  
Feng Gao ◽  
Da-Peng Mo ◽  
Gang Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Local Anesthesia ◽  
Binary Logistic Regression ◽  
Intracranial Artery ◽  
Stent Restenosis ◽  
Intracranial Artery Stenosis ◽  
In Stent Restenosis

Background: For patients with symptomatic intracranial artery stenosis (sICAS), endovascular treatment has been shown to be feasible and safe in recent studies. However, in-stent restenosis (ISR) risks the recurrence of ischemic stroke. We attempt to elucidate the risk factors for ISR.Methods: We retrospectively analyzed 97 patients with sICAS from a prospective registry trial that included 20 centers from September 2013 to January 2015. Cases were classified into the ISR≥ 50% group or the ISR < 50% group. The baseline characteristics and long-term follow-up were compared between the two groups. Binary logistic regression analyses were identified as an association between ISR and endovascular technique factors.Results: According to whether ISR was detected by CT angiography, 97 patients were divided into the ISR group (n = 24) and the non-ISR group (n = 73). The admission baseline features and lesion angiography characteristics were similar, while plasma hs-CRP (mg/L) was higher in the ISR≥ 50% group at admission (8.2 ± 11.4 vs. 2.8 ± 4.1, p = 0.032). Binary logistic regression analysis identified the longer stents (adjusted OR 0.816, 95% CI 0.699–0.953; p = 0.010), balloon-mounted stents (adjusted OR 5.748, 95% CI 1.533–21.546; p = 0.009), and local anesthesia (adjusted OR 6.000, 95% CI 1.693–21.262; p = 0.006) as predictors of ISR at the 1-year follow-up.Conclusions: The longer stents, balloon-mounted stents implanted in the intracranial vertebral or basilar artery, and local anesthesia were significantly associated with in-stent restenosis. Further studies are required to identify accurate biomarkers or image markers associated with ISR in ICAS patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT01968122.

scholarly journals Romanian Patients Who Experience in-Stent Restenosis After St-Elevation Myocardial Infarction: The Experience of a Tertiary Center

2021 ◽  
Vol 18 (2) ◽  
pp. 7-13
Author(s):  
Alice Elena Munteanu ◽  
Liviu Chiriac ◽  
Filip Romi Bolohan ◽  
Daniel Niţă ◽  
Ruxandra Constantinescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Warning Sign ◽  
Stent Restenosis ◽  
Tertiary Center ◽  
History Of ◽  
St Elevation ◽  
In Stent Restenosis

Abstract Background and aim. Coronary artery disease (CAD) is one of the most important causes of death worldwide. ST-elevation myocardial infarction (STEMI) is an acute form of presentation in patients with CAD. Percutaneous coronary intervention (PCI) is the treatment of choice in STEMI patients. Generally, a stent is placed after the culprit lesion is dilated in order to ensure the patency of the coronary artery. In-stent restenosis (ISR) is a possible chronic complication in this setting. The following study is one of the few of its kind, since it investigates ISR in a cohort of Romanian patients who underwent PCI in the setting of STEMI. Our current descriptive study aims at highlighting the characteristics of these patients and identifying potential risk factors in this specific population, which could be validated by a further larger study. Methods. We studied 68 patients from “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest, Romania, who presented with STEMI in 2016. The mean time for angiographic reevaluation was 111 days. Results. 94% (64) of the patients underwent primary PCI, while in 6% (4) of the cases thrombolysis was initially attempted before PCI. The most prevalent risk factors that we identified were: arterial hypertension (61%), dyslipidemia (60%) and smoking or history of smoking (47%). The anterior myocardial infarction was the most prevalent (49%). Only 6% of the patients had a documented history of CAD, while on the other hand chronic occlusions were observed in most patients (85%). Of note is that only 11% of the patients reported recurrent angina before the angiographic reevaluation. Conclusion. Common cardiovascular risk factors are also involved in ISR. Their poor management in the case of Romanian patients with STEMI increases the risk of ISR. The lack of symptoms in patients with ISR constitutes a warning sign for clinicians and shows that ISR is a complication which can be easily omitted. Therefore, its incidence is probably underestimated.

scholarly journals The predictive value of preprocedural laboratory data in patients with coronary artery restenosis in various types of stents

2019 ◽  
Vol 24 (3) ◽  
pp. 54-59
Author(s):  
D. V. Shames ◽  
A. S. Galyavich ◽  
Z. M. Galeeva ◽  
L. V. Baleeva
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Mean Platelet Volume ◽  
Red Cell ◽  
Age Group ◽  
Cell Distribution ◽  
Platelet Volume ◽  
Distribution Width ◽  
Stent Restenosis ◽  
In Stent Restenosis

Aim.To identify the effect of preprocedural laboratory parameters on the occurrence of in-stent restenosis in various types of stents, to assess the significance of gender, age and various forms of coronary artery disease (CAD) as risk factors for coronary artery restenosis after stenting.Material and methods.The study included 436 patients with CAD, which were divided into 2 groups. The study group included 218 patients with in-stent restenosis. The control group consisted of 218 patients with CAD without in-stent restenosis. Inclusion criteria were acute or chronic form of CAD, age 45-74 years, CAG and percutaneous coronary intervention (PCI) with emergency or planned stenting of the native coronary artery, repeated CAG in history due to signs/symptoms of myocardial ischemia. Exclusion criteria: age younger than 45 years and over 74 years, coronary artery bypass surgery (CABG), cancer, autoimmune disease, anemia, liver failure, chronic kidney disease S4-S5, recent blood transfusion, hypo-or hyperthyroidism.Results.According to the study, the risk in-stent restenosis is 5,2 times higher in patients in the 65-69 years age group and 9,9 times higher in the 70-74 years age group compared with the group of young patients (45-49 years). In-stent restenosis is 2,7 times more common in men than in women. Predictors of restenosis were red cell distribution width, mean platelet volume, Gensini score with OR 1,5; 1,4; 1,1; 1,5, respectively.Conclusion.Risk factors for coronary artery restenosis after stenting are markers of chronic inflammation, such as the red cell distribution width, mean platelet volume. The risk of restenosis is higher in the male population. In old age, the risk of restenosis increases, however, young people and middle-aged people do not differ in risk of in-stent restenosis.

Abstract 1122‐000136: Stent Length is Associated with Restenosis of the Vertebral Artery Ostium

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ahsan Ali ◽  
Randall Edgell
Keyword(s):  
Risk Factors ◽  
Vertebral Artery ◽  
University Hospital ◽  
Linear Regression Models ◽  
University Of Iowa ◽  
Saint Louis ◽  
Stent Restenosis ◽  
Stent Length ◽  
In Stent Restenosis

Introduction : Background: Stenosis of the vertebral artery ostium (VAOS), while under‐diagnosed, is common and may cause 25% of posterior circulation infarctions. Stenting is widely employed as a secondary prevention strategy, but is associated with high rates of restenosis. Objective: To identify factors associated with higher risk of VAOS recurrence after stenting. Methods : A combined retrospective cohort of subjects who underwent vertebral ostial stenting at two academic hospitals: SSM Health Saint Louis University Hospital and the University of Iowa, was analyzed. The demographic profile of the subjects, medical comorbidities, periprocedural complications, 30 day complications, and change in Modified Rankin score, and radiographic follow up were analyzed using IBM SPSS Statistics version 26. Results : There were 80 patients who underwent vertebral artery stenting in this cohort. 72.5% (n = 58) were male, 70% (n = 56) were Caucasian. Hypertension (67.5%, n = 54) and hyperlipidemia (65%, n = 52) were the most prevalent vascular risk factors. Of these subjects, 31 underwent radiographic follow up with catheter angiography. The mean interval at which the last angiogram was performed was, 9.3 months (+/‐ 4.3). Independent samples t‐tests and univariate linear regression models revealed that four factors were identified as most associated with in‐stent restenosis: hypertension, diabetes mellitus, stent length, and post‐stent residual stenosis. When analyzed as a backwards stepwise multivariate model, stent length was the only variable that trended towards significance (t = 1.74, p = 0.09). Additionally, only 4 of the 31 patients did not have HTN and none of them had a recurrence of stenosis post‐procedure. Conclusions : Stent length may be associated with risk of recurrent stenosis after vertebral ostial stenting. This along with risk factors such as hypertension should be studied in future prospective studies as possible predictors of in‐stent restenosis.

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