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.

Stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery origin and treatment with the stent-in-stent technique

2007 ◽  
Vol 106 (5) ◽  
pp. 907-911 ◽  
Author(s):  
Seong-Rim Kim ◽  
Min-Woo Baik ◽  
Seung-Hoon Yoo ◽  
Ik-Seong Park ◽  
Sang-Don Kim ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Coronary Stents ◽  
Drug Eluting Stent ◽  
Stent Fracture ◽  
Stent Restenosis ◽  
Stent Strut ◽  
Drug Eluting ◽  
In Stent Restenosis

✓ The authors report two cases of stent fracture and restenosis after placement of a drug-eluting device in the vertebral artery (VA) origin, and describe management of restenosis with the stent-in-stent technique. Two women, one 62 and the other 67 years of age, underwent stent placement in the VA origin to treat symptomatic and angiographically significant stenosis in this vessel. Sirolimus-eluting coronary stents (Cypher) were used in both cases. Four months after placement of the devices, the symptoms recurred. Follow-up angiography performed 5 months after insertion of the devices revealed a transverse stent fracture with separation of the fragments and severe in-stent restenosis in both cases. The restenoses were treated with reinsertion of coronary stents (Cypher and Jostent FlexMaster) by using the stent-in-stent technique. After stent reinsertion, the patients exhibited relief of symptoms. This paper is the first report of fracture in a drug-eluting stent and restenosis after stent placement in the VA origin. Restenosis caused by such a fracture can be managed successfully by performing the stent-in-stent maneuver. The physical properties of metallic devices, stent strut geometry, and anatomical peculiarities of the subclavian artery may be associated with stent fractures. Earlier follow-up angiography studies (within 6 months) are warranted.

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.

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.

P4709Subclavian CTO stenting using bilateral retrograde wrist approach

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Petkoska ◽  
B Zafirovska Taleska ◽  
I Vasilev ◽  
S Antov ◽  
S Kedev
Keyword(s):  
Subclavian Artery ◽  
Guide Wire ◽  
Bleeding Complications ◽  
Access Site ◽  
Transfemoral Approach ◽  
Total Occlusion ◽  
Stent Restenosis ◽  
Stent Length ◽  
In Stent Restenosis

Abstract Aims To assess the procedural safety and results of subclavian artery stenting using bilateral retrograde radial (TRA) and/or ulnar approach (TUA). Methods We report 40 consecutive patients that underwent retrograde opening and stenting of the subclavian artery using wrist approach with contralateral control from the opposite TRA or TUA. Primary outcome was procedural success rate. Secondary outcomes were: presence of procedural complications, restenosis, MI, stroke or death and presence of any type of access site bleeding hemathoma. One year clinical follow up and duplex ultrasonography was done in all patients. Results The same technique was used in all patients: 6F guiding catheter Judkins right 4.0 was most frequently used (n=37) for coronary hydrophilic wire retrograde crossing of the occlusion and ballon predilatation. Exchange of wire was made with 0,035 guide wire. Balloon expandable stents were implanted solely through the short hydrophilic sheath, with contralateral contrast check. Contralateral injection strategy was used to confirm proper wire advancement within the lesion and optimal stent positioning. Most frequently used guide wire for CTO opening was CROSS IT 400. The average stent diameter was 7 mm (range 5.0–9.0 mm), and the average stent length was 29, 1 mm (range 15–80 mm). 38 procedures were successfully done using bilateral retrograde radial approach. Only two patients required transfer to transfemoral approach to open the subclavian chronic total occlusion. Minor access site bleeding complications were recorded in 4 patients. There were no other complications. Seven patients were discharged the same day, the others one day after admission. At follow up only one patient had symptomatic in stent restenosis and a balloon angioplasty was done inside the stent 3 years after the primary intervention, the patient was a smoker. One other patient had asymptomatic in stent restenosis documented 6 months after the intervention with duplex follow up. Conclusions Bilateral wrist access can be a successful and safe strategy in opening subclavian artery occlusions with a low rate of complications.

scholarly journals The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Chengbin Zheng ◽  
Jeehoon Kang ◽  
Kyung Woo Park ◽  
Jung-Kyu Han ◽  
Han-Mo Yang ◽  
...  
Keyword(s):  
Target Lesion ◽  
University Hospital ◽  
Target Lesion Revascularization ◽  
Drug Eluting Stent ◽  
2Nd Generation ◽  
Stent Restenosis ◽  
Significant Difference ◽  
Drug Eluting ◽  
In Stent Restenosis

Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

scholarly journals Effects of the Vertebral Artery Ostium/Subclavian Artery Angle on In-Stent Restenosis after Vertebral Artery Ostium Stenting

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Hui Su ◽  
Shengyuan Yu ◽  
Chenglin Tian ◽  
Zhihua Du ◽  
Xinfeng Liu ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Subclavian Artery ◽  
Disease Risk ◽  
Patient Demographics ◽  
Stent Restenosis ◽  
Potential Factors ◽  
Ischemic Attack ◽  
In Stent Restenosis ◽  
Related Mortality

Background and Purpose. The cause of in-stent restenosis (ISR) after vertebral artery ostium (VAO) stenting remains unclear. We evaluated factors associated with ISR in patients who underwent VAO stenting. We also assessed the feasibility of stenting for treating VAO stenosis (VAOS). Methods. Between January 2016 and October 2018, sixty-four consecutive patients who underwent a total of 66 stenting procedures were screened for symptomatic and asymptomatic atherosclerotic VAOS. Of these patients, 57 had complete follow-up data. The baseline patient demographics and morphological features of the VAO were recorded. Potential factors influencing ISR, including conventional cerebrovascular disease risk factors, were assessed, together with outcome events including recurrent transient ischemic attack (TIA), stroke, and vascular-related mortality. Results. The average follow-up period was 13.2 ± 4.6 months. Technical success was achieved in all interventions. The degree of stenosis was reduced from 77.2 ± 6.1 % to 13.7 ± 8.9 % after the procedure. ISR was detected in eight treated vessels (14.0%) and occlusion in two (5.3%) arteries. Of the 57 patients, one had an ischemic stroke and 5 had TIAs. The angle of the VAO at the subclavian artery was associated with the risk of restenosis (preoperative, P = 0.04 ; postoperative, P = 0.02 ). Conclusions. Stenting is a feasible and effective treatment for VAOS. The angle of the VAO at the subclavian artery may contribute to the development of ISR.

scholarly journals Risk factors for revascularization and in-stent restenosis in patients with triple-vessel disease after second-generation drug-eluting stent implantation: a retrospective analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
MengYing Zeng ◽  
XiaoWei Yan ◽  
Wei Wu
Keyword(s):  
Risk Factors ◽  
Second Generation ◽  
Drug Eluting Stent ◽  
Current Smoking ◽  
Vessel Disease ◽  
Stent Restenosis ◽  
Triple Vessel Disease ◽  
Drug Eluting ◽  
In Stent Restenosis

Abstract Objectives Coronary artery disease (CAD) is a common cardiac disease with high morbidity and mortality, and triple-vessel disease (TVD) is a severe type of CAD. This study investigated risk factors for revascularization and in-stent restenosis (ISR) in TVD patients who underwent second-generation drug-eluting stent implantation. Methods A retrospective clinical study was conducted, and 246 triple-vessel disease (TVD) patients with 373 vessels after second-generation drug-eluting stent (DES) implantation who received follow-up coronary angiography (CAG) were consequently enrolled. According to the follow-up angiography, patients were categorized into the revascularization group and nonrevascularization group as well as the in-stent restenosis (ISR) group and non-ISR group. Univariate and multivariate logistic regression analyses were used to identify risk factors for revascularization and ISR. Receiver operating characteristic (ROC) curve with area under the curve (AUC) analysis was performed to assess the predictive power of these risk factors. Results In the median follow-up period of 28.0 (14.0, 56.0) months, 142 TVD patients (57.7%) with 168 vessels underwent revascularization, and ISR occurred in 43 TVD patients (17.5%) with 47 vessels after second-generation DES implantation. Compared to the nonrevascularization group, the revascularization group presented with an increased rate of current smoking and higher levels of TC, LDL-C, HDL-C, non-HDL-c, ApoB, neutrophils, and Hs-CRP as well as a longer follow-up of months but with a lower level of HDL-C. In addition, patients in the ISR group had an older age, longer follow-up (months) and elevated rates of current smoking and stage 4–5 chronic kidney disease (CKD4-5). In multivariate analysis, current smoking and higher non-HDL-c were independent risk factors for revascularization. In addition, older age, current smoking and CKD4-5 were considered independent risk factors for ISR. Importantly, the receiver operating characteristic curve showed that non-HDL-C and age displayed predictive power for revascularization and ISR, respectively. Conclusion Current smoking is an independent risk factor for both revascularization and in-stent restenosis. Higher non-HDL-c is independently related to revascularization; moreover, increased age and CKD4-5 are potential risk factors for ISR in TVD patients after second-generation drug-eluting stent implantation.

scholarly journals Occurrence and predictive risk factors associated with in-stent restenosis after drug-eluting stent implantation in diabetic patients: a prospective, clinical cohort study

2020 ◽  
Author(s):  
ShengGang Zhao ◽  
Jian-Jiang Xu ◽  
Li-Qin Jiang ◽  
Zhen-Liang Chu ◽  
An-Qian Tao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Density Lipoprotein ◽  
Inflammatory Factors ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Dynamic Observation ◽  
Drug Eluting ◽  
In Stent Restenosis

Abstract Background The incidence of in-stent restenosis (ISR) in patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) is significantly higher than that in patients without DM, but the mechanism is not clear. We hypothesised that patients with and risk factors including dyslipidaemia, elevated inflammatory factors would be prone to induction of ISR, and that dynamic observation of the comprehensive risk factor changes before and after PCI would be helpful to identify ISR . Methods This prospective cohort study consecutively enrolled 360 patients who received coronary drug-eluting stent implantation. Patients who underwent coronary angiography (CAG) and received clinical follow-up were prospectively reviewed. The patients were assigned to a DM (262) or a non-DM (98) group. The patients were further assigned according to whether ISR was present to the non-DM + non-ISR, non-DM + ISR, DM + non-ISR, and DM + ISR groups. The patients were further assigned according to whether low-density lipoprotein (LDL-c) was decreased more than 50% compared with baseline, or was less than 1.80 mmol/L in the follow-up, to the LDL-c achieved or the LDL-c failure groups. Results DM patients were prone to develop ISR after PCI and the degree of coronary stenosis was more severe than in non-DM patients. This result was more striking in DM and LDL-c failure patients. The levels of total cholesterol (TC), triglyceride, high-density lipoprotein (HDL-c), LDL-c, apolipoprotein B100, apolipoprotein E, remnant lipoprotein, TC/HDL-c ratio and triglyceride/HDL-c ratio in the DM + non-ISR were similar to those in the DM + ISR group before PCI and CAG. .The DM + ISR group had the highest levels of haemoglobin A1c and the highest Gensini scores. The inflammatory index changes including leukocytes and neutrophils were the most striking in the DM + ISR group. In multivariate regression analysis, neutrophil changes and glycosylated haemoglobin were independent risk factors for ISR [△neutrophil, OR 1.929,95% CI 1.216–3.058; HbA1-c OR 1.559,95% CI 1.001–1.707]. Conclusion Coronary artery disease patients with DM had a high risk for ISR if they had preoperative risk factors including dyslipidaemia, elevated inflammatory factors, and a high Gensini score. Dynamic observation of the changes of the preoperative and postoperative comprehensive risk factors was helpful to identify ISR in patients with DM.

scholarly journals Risk factors of in-stent restenosis among coronary artery disease patients with syphilis undergoing percutaneous coronary intervention: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ling Zhang ◽  
Yu Wang ◽  
Zhe Zhang ◽  
Hongyuan Liang ◽  
Liang Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Clinical Intervention ◽  
Coronary Intervention ◽  
Stent Restenosis ◽  
Percutaneous Coronary ◽  
Stent Length ◽  
Artery Disease ◽  
In Stent Restenosis

Abstract Background The risk factors of in-stent restenosis (ISR) among coronary artery disease (CAD) patients with syphilis after percutaneous coronary intervention (PCI) are not fully understood. Therefore, this study aimed to elucidate not only the risk factors of ISR among CAD patients with syphilis after performing PCI, but also the population attributable risk percentage (PAR%), which is used to quantify the proportion of ISR that could be eliminated if particular risk factors are not present. Methods Evaluation of the prevalence, risk factors, and their PAR% for ISR among CAD patients with syphilis undergoing PCI was conducted retrospectively at Beijing Ditan Hospital. CAD patients with syphilis underwent PCI from August 2010 to August 2019 and received a diagnosis, coronary angiography, PCI, and periodical follow-up. The clinical, laboratory, and imaging data were reviewed and summarised anonymously from electronic medical records. The chi-square or Fisher exact test was used in data analysis. Results Among 114 CAD patients with syphilis undergoing PCI, ISR occurred in 18 patients (15.78%). The multivariate Cox regression model indicated that average stent length ≥ 35 mm (adjusted hazard ratio [HR] = 4.47, 95% confidence interval [CI] = 1.30–15.44, p = 0.018) and titres of the toluidine red unheated serum test (TRUST) > 1:16 (adjusted HR = 3.72, 95% CI = 1.22–11.36, p = 0.021) were associated with an increased risk of ISR, while successful antisyphilitic treatment (adjusted HR = 0.12, 95% CI = 0.02–0.95, p = 0.045) was protective predictor of ISR among these patients. The PAR% values of particular risk factors associated with ISR including average stent length ≥ 35 mm, titres of TRUST > 1:16, and successful antisyphilitic treatment were 12.2%, 24.0%, and -39.6%, respectively, among these patients. Conclusions Preventing the occurrence of ISR among CAD patients with syphilis undergoing PCI requires clinical intervention. Our results indicated that carefully evaluating the length of the vessel lesion to determine whether the stent length is < 35 mm, prioritising the clinical intervention for titres of TRUST > 1:16, and providing successful antisyphilitic treatment could reduce the risk of ISR occurrence.

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