The impact of carotid artery plaque echogenicity on the rate of solid cerebral microembolism during carotid artery stenting

BackgroundWhile dual antiplatelet therapy (dAPT) is standard of care following carotid artery stenting (CAS), the optimal dAPT regimen and duration has not been established.MethodsWe canvassed a large national database (IBM MarketScan) to identify patients receiving carotid endarterectomy (CEA) or CAS for treatment of ischemic stroke or carotid artery stenosis from 2007 to 2016. We performed univariable and multivariable regression methods to evaluate the impact of covariates on post-CAS stroke-free survival, including post-discharge antiplatelet therapy.ResultsA total of 79 084 patients diagnosed with ischemic stroke or carotid stenosis received CEA (71 178; 90.0%) or CAS (7906; 10.0%). After adjusting for covariates, <180 days prescribed post-CAS P2Y12-inhibition was associated with increased risk for stroke (<90 prescribed days HR=1.421, 95% CI 1.038 to 1.946; 90–179 prescribed days HR=1.484, 95% CI 1.045 to 2.106). The incidence of hemorrhagic complications was higher during the period of prescribed P2Y12-inhibition (1.16% per person-month vs 0.49% per person-month after discontinuation, P<0.001). The rate of extracranial hemorrhage was nearly six-fold higher while on dAPT (6.50% per patient-month vs 1.16% per patient-month, P<0.001), and there was a trend towards higher rate of intracranial hemorrhage that did not reach statistical significance (5.09% per patient-month vs 3.69% per patient-month, P=0.0556). Later hemorrhagic events beyond 30 days post-CAS were significantly more likely to be extracranial (P=0.028).ConclusionsIncreased duration of post-CAS dAPT is associated with lower rates of readmissions for stroke, and with increased risk of hemorrhagic complications, particularly extracranial hemorrhage. The potential benefit of prolonging dAPT with regard to ischemic complications must be balanced with the corresponding increased risk of predominantly extracranial hemorrhagic complications.

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Expression of P-selectin, von Willebrand and endothelin-1 after carotid artery stenting

VASA ◽

10.1024/0301-1526/a000094 ◽

2011 ◽

Vol 40 (3) ◽

pp. 199-204 ◽

Cited By ~ 8

Author(s):

Xia ◽

Yang ◽

Qu ◽

Cheng ◽

Wang

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Endothelin 1 ◽

Significant Difference ◽

Group 2 ◽

One Year ◽

Von Willebrand ◽

The Impact ◽

Group 1

Background: This study was designed to investigate the impact of carotid artery stenting (CAS) on plasma levels of P-selectin, von Willebrand (vWF) and endothelin-1. Patients and methods: Sixty-seven patients who received CAS were divided into group 1 (one stent for a simple lesion, n = 38) and group 2 (two stents for complex lesions, n = 29). The levels of P-selectin, vWF and endothelin-1 were measured before CAS, 1 h, 6h, 24 h and 2 weeks after the stenting. Results: Sixty-one patients completed one-year follow up. Restenosis was noted in 14 (23 %) patients, among these three (4.8 %) had a restenosis of > 50 % of the vascular lumen. In all patients, the levels of P-selectin, vWF and endothelin-1 increased immediately after CAS (P < 0.05 or < 0.01). The levels of vWF and endothelin-1 in group 2 were higher than in group 1 (P < 0.05 or 0.01). There was no significant difference in P-selectin and endothelin-1 between the restenosis and non-restenosis group (P > 0.05). The 24 h vWF in patients with restenosis were higher than in non-restenosis group (P < 0.05). Conclusions: CAS results in a significant increase in plasma P-selectin, vWF and endothelin-1. The post-CAS levels of P-selectin, vWF and endothelin-1 are related to the extent of endothelial injury. Whether they are associated with restenosis 12 months after the treatment requires further investigation.

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PVSS17. The Impact of Centers for Medicaid & Medicare Services (CMS) High-Risk (HR) Criteria on Outcome after Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) in the SVS Vascular Registry (VR)

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.03.058 ◽

2012 ◽

Vol 55 (6) ◽

pp. 12S

Author(s):

Marc L. Schermerhorn ◽

Philip P. Goodney ◽

Ellen D. Dillavou ◽

Jeffrey Jim ◽

Christopher T. Kenwood ◽

...

Keyword(s):

High Risk ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

The Impact

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Risk Factors for Residual Stenosis After Carotid Artery Stenting

Frontiers in Neurology ◽

10.3389/fneur.2020.606924 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yunlu Tao ◽

Yang Hua ◽

Lingyun Jia ◽

Liqun Jiao ◽

Beibei Liu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Carotid Artery ◽

Logistic Regression Analysis ◽

Carotid Artery Stenting ◽

Protective Factor ◽

Expansion Rate ◽

Carotid Artery Plaque ◽

Residual Stenosis

Background and purpose: Stent residual stenosis is an independent risk factor for restenosis after stenting. This study aimed to analyze the factors influencing residual stenosis after carotid artery stenting (CAS).Methods: A total of 570 patients who underwent CAS with 159 closed-loop stents (CLS) and 411 open-loop stents (OLS) from January 2013 to January 2016 were retrospectively enrolled in this study. Carotid stenosis location in the common carotid artery or in internal carotid artery, plaque size, and features (regular or irregular morphology; with or without calcification), degree of carotid artery stenosis, and stent expansion rate were detected by carotid duplex ultrasonography. Residual stenosis was defined as a stenosis rate ≥30% after CAS, as detected by digital subtraction angiography. A logistic regression analysis was used to analyze residual stenosis risk factors.Results: The overall incidence of residual stenosis was 22.8% (130/570 stents). The incidence of residual stenosis in the CLS group was higher than that in the OLS group (29.5 vs. 20.2%, χ2 = 5.71, P = 0.017). The logistic regression analysis showed that CLS [odds ratio (OR), 1.933; 95% confidence interval (CI), 1.009–3.702], irregular plaques (OR, 4.237; 95% CI, 2.391–7.742), and plaques with calcification (OR, 2.370; 95% CI, 1.337–4.199) were independent risk factors for residual stenosis after CAS. In addition, a high radial expansion rate of stent was a protective factor for residual stenosis (OR, 0.171; 95% CI, 0.123–0.238). The stenosis location and stent length did not impact the occurrence of residual stenosis. After 1-year follow-up, the incidence of restenosis in the residual stenosis group was higher than that in the group without residual stenosis (13.1 vs. 2.0%, χ2 = 28.05, P < 0.001).Conclusions: The findings of this study suggest that plaque morphology, echo characteristics (with calcification), and stents type influence residual stenosis.

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