scholarly journals The CRP/albumin ratio: a novel predictor of in-stent restenosis after carotid artery stenting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N Calik ◽  
T Cinar ◽  
D Inan ◽  
D Genc ◽  
H Kuplay ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Independent Predictor ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Stent Restenosis ◽  
In Stent Restenosis

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

Effect of Open- vs Closed-Cell Stent Design on Periprocedural Outcomes and Restenosis After Carotid Artery Stenting: A Systematic Review and Comprehensive Meta-analysis

2018 ◽  
Vol 25 (4) ◽  
pp. 523-533 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Giuseppe Lanzino
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Stent Design ◽  
Open Cell ◽  
Stent Restenosis ◽  
Closed Cell ◽  
Ischemic Attack ◽  
In Stent Restenosis

Purpose:To compare periprocedural complications and in-stent restenosis rates associated with open- vs closed-cell stent designs used in carotid artery stenting (CAS). Methods: A systematic search was conducted to identify all randomized and observational studies published in English up to October 31, 2017, that compared open- vs closed-cell stent designs in CAS. Identified studies were included if they reported the following outcomes: stroke, transient ischemic attack (TIA), myocardial infarction (MI), hemodynamic depression, new ischemic lesions detected on imaging, and death within 30 days, as well as the incidence of in-stent restenosis. A random-effects model meta-analysis was employed. Model results are reported as the odds ratio (OR) and 95% confidence interval (CI). The I2 statistic was used to assess heterogeneity. Results: Thirty-three studies (2 randomized trials) comprising 20, 291 patients (mean age 71.3±3.0 years; 74.6% men) were included. Patients in the open-cell stent group had a statistically significant lower risk of restenosis ⩾40% (OR 0.42, 95% CI 0.19 to 0.92; I2=0%) and ⩾70% (OR 0.23, 95% CI 0.10 to 0.52; I2=0%) at a mean follow-up of 24 months. No statistically significant differences were identified for periprocedural stroke, TIA, new ischemic lesions, MI, hemodynamic depression, or death within 30 days after CAS. Sensitivity analysis of the 2 randomized controlled trials only did not point to any significant differences either. Conclusion: Use of open-cell stent design in CAS is associated with a decreased risk for restenosis when compared to the closed-cell stent, without significant differences in periprocedural outcomes.

scholarly journals The long-term prognostic significance of high-sensitive C-reactive protein to in-stent restenosis

Medicine ◽  
2018 ◽  
Vol 97 (27) ◽  
pp. e10679 ◽  
Author(s):  
Xinyi Zhu ◽  
Yuqi Chen ◽  
Li Xiang ◽  
Tao You ◽  
Yang Jiao ◽  
...  
Keyword(s):  
Prognostic Significance ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals The association of preprocedural C-reactive protein/albumin ratio with in-stent restenosis in patients undergoing iliac artery stenting

2020 ◽  
Vol 12 (3) ◽  
pp. 179-184
Author(s):  
Ali Nazmi Çalık ◽  
Duygu İnan ◽  
Mehmet Baran Karataş ◽  
Evliya Akdeniz ◽  
Duygu Genç ◽  
...  
Keyword(s):  
Iliac Artery ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
Stent Restenosis ◽  
In Stent Restenosis

In-stent restenosis after interventional treatment of carotid artery stenoses: a long-term follow-up of a single center cohort

2017 ◽  
Vol 106 (7) ◽  
pp. 493-500 ◽  
Author(s):  
J. Kammler ◽  
H. Blessberger ◽  
T. Lambert ◽  
J. Kellermair ◽  
M. Grund ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Interventional Treatment ◽  
Single Center ◽  
Stent Restenosis ◽  
Long Term Follow Up ◽  
In Stent Restenosis

Late Outcomes of Carotid Artery Stenting for Radiation Therapy-Induced Carotid Stenosis

2022 ◽  
pp. 152660282110687
Author(s):  
Bahaa Nasr ◽  
Valentin Crespy ◽  
Edouard Penasse ◽  
Marine Gaudry ◽  
Eugenio Rosset ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Mortality Rate ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Target Lesion ◽  
Long Term Outcomes ◽  
Stent Restenosis ◽  
In Stent Restenosis

Purpose: Carotid artery stenting (CAS) appears as a promising alternative treatment to carotid endarterectomy for radiation therapy (RT)-induced carotid stenosis. However, this is based on a poor level of evidence studies (small sample size, primarily single institution reports, few long-term data). The purpose of this study was to report the long-term outcomes of a multicentric series of CAS for RT-induced stenosis. Methods: All CAS for RT-induced stenosis performed in 11 French academic institutions from 2005 to 2017 were collected in this retrospective study. Patient demographics, clinical risk factors, elapsed time from RT, clinical presentation and imaging parameters of carotid stenosis were preoperatively gathered. Long-term outcomes were determined by clinical follow-up and duplex ultrasound. The primary endpoint was the occurrence of cerebrovascular events during follow-up. Secondary endpoints included perioperative morbidity and mortality rate, long-term mortality rate, primary patency, and target lesion revascularization. Results: One hundred and twenty-one CAS procedures were performed in 112 patients. The mean interval between irradiation and CAS was 15 ± 12 years. In 31.4% of cases, the lesion was symptomatic. Mean follow-up was 42.5 ± 32.6 months (range 1–141 months). The mortality rate at 5 years was 23%. The neurologic event-free survival and the in-stent restenosis rates at 5 years were 87.8% and 38.9%, respectively. Diabetes mellitus (p=0.02) and single postoperative antiplatelet therapy (p=0.001) were found to be significant predictors of in-stent restenosis. Freedom from target lesion revascularization was 91.9% at 5 years. Conclusion: This study showed that CAS is an effective option for RT-induced stenosis in patients not favorable to carotid endarterectomy. The CAS was associated with a low rate of neurological events and reinterventions at long-term follow-up.

Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment

Vascular ◽  
2021 ◽  
pp. 170853812110251
Author(s):  
Muhammed Süleymanoğlu ◽  
Cengiz Burak ◽  
Ayça Gümüşdağ ◽  
Murat Çap ◽  
Ayhan Şenol ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Independent Predictor ◽  
Arterial Disease ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
Peripheral Arterial

Background Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. Method Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution’s medical records. Results The mean follow-up period was 22 months (14–40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan–Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. Conclusion The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

scholarly journals Angioplasty and carotid artery stenting: clinical and morphological factors affecting long-term outcomes

2020 ◽  
Vol 19 (3) ◽  
pp. 2470
Author(s):  
F. B. Shukurov ◽  
E. S. Bulgakova ◽  
B. A. Rudenko ◽  
N. E. Gavrilova ◽  
T. V. Tvorogova ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Adverse Events ◽  
Carotid Artery Stenting ◽  
Lesion Length ◽  
Open Cell ◽  
Factors Affecting ◽  
Residual Stenosis ◽  
Stent Restenosis

Aim. To identify clinical and morphological factors affecting the longterm outcomes of endovascular angioplasty and carotid artery stenting.Material and methods. The analysis included 198 patients after carotid artery stenting between 03.2014 and 05.2018. There were following inclusion criteria: (1) 50% of symptomatic or 70% of asymptomatic carotid artery stenosis of according to NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria; (2) follow-up for each patient for at least 1 year. Using the univariate and multivariate logistic regression, risk factors associated with adverse events were determined.Results. The incidence of major adverse events during the 12-month follow-up was 9,6% (n=19), including 4 (2%) major and 6 (3%) minor strokes, 7 (3,5%) cases of transient ischemic attack; one (0,5%) patient had transient blindness and one (0,5%) died in the long-term follow-up period due to acute cerebrovascular accident in the target arterial territory. Also, 11 (5,6%) patients had restenosis >50% after 12-month follow-up. Multivariate analysis showed that long-term outcomes were significantly affected by: age >70 years (odds ratio (OR)=1,27, 95% confidence interval (CI): 1,07-1,61 (p=0,01); using of open-cell stents (OR=1,02, 95% CI: 1,01-1,03 (p=0,034)); contralateral stenosis (OR=1,28, 95% CI: 1,05-1,57 (p=0,01); lesion length >15 mm (OR=1,46, 95% CI: 1,12-1,89 (p=0,01)); residual stenosis <30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis ><30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02). Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >< 30% (OR=1,38, 95% CI: 1,09-1,49 (p=0,012)); complicated atherosclerotic plaque (OR=1,78, 95% CI: 1,21- 2,34 (p=0,007)). The development of in-stent restenosis was significantly influenced by factors such as the residual stenosis <30% (OR=1,26, 95% CI: 1,1-1,65; p=0,017) and severe plaque calcification (OR=1,24, 95% CI: 1,04-1,31; p=0,02).Conclusion. The results obtained indicate the need for more careful preparation for endovascular intervention. Such factors as the use of open-cell stents, contralateral stenosis, lesion length >15 mm, and residual stenosis < 30% may be associated with an increased risk of adverse events.

Continuous daily use of cilostazol prevents in-stent restenosis following carotid artery stenting: serial angiographic investigation of 229 lesions

2015 ◽  
Vol 8 (5) ◽  
pp. 471-475 ◽  
Author(s):  
Yuichi Miyazaki ◽  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yoshinori Aoyagi ◽  
Yuhei Tanno ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cox Regression ◽  
Rank Test ◽  
Adjusted Relative Risk ◽  
Cox Regression Analysis ◽  
Stent Restenosis ◽  
Significant Difference ◽  
In Stent Restenosis

BackgroundSeveral studies have reported that cilostazol (CLS) may reduce in-stent restenosis (ISR) after carotid artery stenting (CAS). However, it is not known for how long CLS must be continued to prevent ISR.MethodsWe retrospectively reviewed a prospectively collected database of patients who underwent elective CAS and follow-up angiography at 3 months and 1 year after the procedure. ISR was defined as stenosis of 50% or greater on digital subtraction angiography. The cumulative incidence rates of angiographic ISR were compared between the three groups, divided according to duration of CLS use : (1) patients who were maintained on CLS for 12 months or more after CAS (12M CLS group, n=70), (2) patients who were treated with CLS for the first 3 months after CAS (3M CLS group, n=23), and (3) patients who did not receive CLS (no CLS group, n=136).ResultsA total of 229 lesions in 199 patients were included in our analysis. During a median follow-up of 365 days, ISR was detected in 15 lesions. The cumulative ISR rates overall and in the 12M CLS, 3M CLS, and no CLS groups were 5.6%, 0%, 5.0%, and 8.4%, respectively, at 1 year, and the log rank test showed that there was a significant difference between the three groups (p<0.05). Cox regression analysis demonstrated that the 12M CLS group had a significantly lower risk of ISR than the 3M CLS group (adjusted relative risk (aRR) 3.06e-10, 95% CI 0 to 0.51, p<0.05) and the no CLS group (aRR 1.41e-10, 95% CI 0 to 0.15, p<0.001), whereas no difference was found between the 3M CLS group and the no CLS group.ConclusionsAn overall cumulative ISR rate of 5.6% was documented angiographically at 1 year after CAS. Continuous daily use of CLS (for at least 1 year) may have a beneficial effect on long term prevention of ISR.

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