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.

Abstract 81: Recurrent Stroke Risk After Angioplasty and Stenting for Symptomatic Intracranial Stenosis: Data From the SAMMPRIS Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Colin Derdeyn ◽  
David Fiorella ◽  
Tanya Turan ◽  
Jean Montgomery ◽  
Bethany Lane ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Primary Endpoint ◽  
Imaging Modality ◽  
Recurrent Stroke ◽  
Intracranial Stenosis ◽  
Stent Restenosis ◽  
Primary Endpoints ◽  
Angioplasty And Stenting ◽  
In Stent Restenosis

Purpose: To investigate the incidence and clinical characteristics of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting for symptomatic intracranial stenosis. Methods: Primary endpoints in SAMMPRIS (Stenting and Aggressive Medical Management for the Prevention of Recurrent Ischemic Stroke) after 30 days past enrollment were defined as ischemic stroke in the territory or any stroke or death within 30 days of a subsequent revascularization procedure. Endpoints were independently and blindly adjudicated. Study records and imaging studies of subjects randomized to the stent arm with post-30 day primary endpoints were reviewed. Instent restenosis (ISR) was categorized as severe (>70%), moderate (50-69%) or mild (< 50%) based on consensus of two reviewers. Findings were categorized as definite, probable, or indeterminate based on imaging modality and study quality. Results: 224 subjects were randomized to the stent arm and 33 suffered a primary endpoint within 30 days of enrollment. Nineteen of the remaining 191 subjects (9.9%) suffered a primary endpoint during follow up (median follow up of 32.4 months). Eighteen had an ischemic stroke in the territory and one had a symptomatic intracranial hemorrhage after repeat angioplasty for in stent restenosis (ISR). In the 18 patients with ischemic stroke, the vascular imaging findings were: complete stent occlusion in 2 (1 of these was acutely revascularized and severe underlying ISR was identified), severe ISR by catheter angiography in 5, severe ISR or occlusion by computed tomographic angiography (CTA) in 1, probable ISR by CTA or magnetic resonance angiography (MRA) in 3, moderate stenosis on angiography in 2 (1 with ISR and 1 with a residual stenosis), indeterminate in 2, normal in 2, and not done in 1. Lesion locations included: distal internal carotid (6), petrous carotid (1), basilar (5), middle cerebral (6), and vertebral (1) arteries. Median time to recurrent stroke was 7.7 months from enrollment (2.2 to 28.2 months). Conclusions: The incidence of recurrent stroke beyond 30 days after uncomplicated angioplasty and stenting in the SAMMPRIS trial was nearly 10% over a mean follow-up of almost 3 years. In stent restenosis was associated with the majority of recurrent strokes.

scholarly journals PS82. Carotid Endarterectomy for Treatment of In-Stent Restenosis after Carotid Angioplasty and Stenting

2011 ◽  
Vol 53 (6) ◽  
pp. 51S
Author(s):  
Boudewijn L. Reichmann ◽  
Jorinde H. van Laanen ◽  
Jean-Paul de Vries ◽  
Johanna M. Hendriks ◽  
Hence J. Verhagen ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Angioplasty ◽  
Stent Restenosis ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
In Stent Restenosis

The impact of therapeutic mediastinal radiation on stent healing in cancer patients: An optical coherence tomography study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19096-e19096
Author(s):  
Jordan Graham ◽  
Moez Aziz ◽  
Teodora Donisan ◽  
Dinu Valentin Balanescu ◽  
Nicolas Palaskas ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Advanced Cancer Patients ◽  
Mediastinal Radiation ◽  
Stent Restenosis ◽  
Radiation Group ◽  
History Of ◽  
In Stent Restenosis

e19096 Background: Cancer is a prothrombotic and proinflammatory state. Understanding stent healing in cancer patients could modify the approach to antiplatelet regimen and facilitate cancer treatment. Mediastinal radiation therapy brings an additional layer of complexity to an already challenging clinical scenario in cancer patients undergoing percutaneous coronary intervention (PCI). We sought to compare stent healing patterns with and without a history of mediastinal radiation therapy using optical coherence tomography (OCT) data. Methods: All cancer patients that underwent PCI and follow-up OCT less than 12 months post-PCI between 2009-2018 were retrospectively identified from our institutional cardiac catheterization laboratory registry. Stent healing, which was defined by a combination of stent and strut coverage, apposition, expansion, in-stent restenosis, and neo-intimal hyperplasia, was compared among 2 groups of oncological PCI patients: those with and without a history of mediastinal radiation therapy. Differences among the two categories were assessed using linear-effect models. Results: There were 86 cancer patients who received PCI with follow-up OCT within 12 months. Of these, 22% received mediastinal radiation. There was no statistical difference in baseline characteristics (hypertension, dyslipidemia, diabetes, etc.) between the two studied groups. In the non-radiation group, 59% were late stage or advanced cancer patients, while 63% of patients in the radiation group were advanced cancer patients. Stent healing was similar among those who had received radiation therapy and those who had not (Table). Conclusions: A history of mediastinal radiation does not appear to affect early stent healing within 1 year of PCI. Given stent healing appears to be similar with or without radiation, dual anti-platelet therapy regimens may not need to change based on radiation exposure alone. Future studies should address the duration of dual antiplatelet regimens and long-term outcomes (i.e. in-stent restenosis) based on stent healing properties. [Table: see text]

Restenosis after carotid artery stenting

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 576-586 ◽  
Author(s):  
Zhengze Dai ◽  
Gelin Xu
Keyword(s):  
Carotid Stenosis ◽  
Influential Factors ◽  
Long Term Outcomes ◽  
Stent Restenosis ◽  
Common Etiology ◽  
Drug Eluting ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

As a common etiology for ischemic stroke, atherosclerotic carotid stenosis has been targeted by vascular surgery since 1950s. Compared with carotid endarterectomy, carotid angioplasty and stenting (CAS) is almost similarly efficacious and less invasive. These advantages make CAS an alternative in treating carotid stenosis. However, accumulative evidences suggested that the long-term benefit-risk ratio of CAS may be decreased or even neutralized by the complications related to in-stent restenosis (ISR). Therefore, investigating the mechanisms and identifying the influential factors of ISR are of vital importance for improving the long-term outcomes of CAS. As responses to intrinsic and extrinsic injuries, intimal hyperplasia and vascular smooth muscle cell proliferation have been regarded as the principle mechanisms for ISR development. Due to the lack of consensus-based definition and consistent follow-up protocol, the reported incidences of ISR after CAS varied widely among studies. These variations made the inter-study comparisons of ISR largely illogical. To eliminate restenosis after CAS, both surgery and endovascular procedures have been attempted with promising results. For preventing ISR, drug-eluting stents and antiplatelets have been proposed as potential solutions.

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 &lt; 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.

Neutrophil to Lymphocyte Ratio as a Predictor of Restenosis After Angioplasty and Stenting for Asymptomatic Carotid Stenosis

Angiology ◽  
2018 ◽  
Vol 70 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Zhengze Dai ◽  
Rongrong Li ◽  
Nan Zhao ◽  
Yunfei Han ◽  
Mengmeng Wang ◽  
...  
Keyword(s):  
Cox Regression ◽  
Inflammatory Marker ◽  
Vital Role ◽  
Neutrophil To Lymphocyte Ratio ◽  
Radiographic Evaluation ◽  
Lymphocyte Ratio ◽  
Stent Restenosis ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting ◽  
In Stent Restenosis

The inflammatory response plays a vital role in the development of in-stent restenosis (ISR) after carotid angioplasty and stenting (CAS). The neutrophil to lymphocyte ratio (NLR) has been suggested as a sensitive inflammatory marker. We explored the association between NLR and ISR in CAS patients. A total of 427 patients who underwent CAS were enrolled. Neutrophil to lymphocyte ratio was measured before the procedure. Clinical examination and radiographic evaluation were performed at 6 months and annually after the procedure. In-stent restenosis was defined as ≥50% stenosis in the treated lesion. Cox regression was used to identify predictors of ISR after CAS. Of the 459 arteries (in 427 patients) with CAS, 72 (15.7%) were identified with ISR during a mean follow-up of 14.6 (19.1) months (range, 0.7-120.7 months). Increased NLR (≥2.13) was significantly related to ISR in patients with asymptomatic stenosis ( P = .001). However, significance was not observed in symptomatic stenosis. On multivariate analysis, baseline NLR ≥ 2.13 (hazard ratio [HR], 2.74; 95% confidence interval [CI], 1.46-5.14), smoking (HR, 1.99; 95% CI, 1.11-3.58), residual stenosis (HR, 1.12; 95% CI, 1.09-1.15), and baseline glucose level (HR, 1.01; 95% CI, 1.01-1.02) were associated with ISR. Elevated NLR may be a predictor of ISR after CAS for asymptomatic stenosis.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document