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.

Carotid Duplex Velocity Criteria Revisited for the Diagnosis of Carotid In-Stent Restenosis

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 119-125 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Damian Maxwell ◽  
Kris Eads ◽  
Sarah K. Flaherty ◽  
Tabitha Stutler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Angiography ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Carotid Angiography ◽  
Residual Stenosis ◽  
Stent Restenosis ◽  
The Mean ◽  
In Stent Restenosis

Carotid percutaneous transluminal angioplasty/stenting has become an accepted treatment modality for carotid artery stenosis in high-risk patients. There has been an ongoing debate regarding which duplex ultrasound (DUS) criteria to use to determine the rate of in-stent restenosis. This prospective study revisits DUS criteria for determining the rate of in-stent restenosis. In analyzing a subset of 12 patients (pilot study) who had both completion carotid angiography and DUS within 30 days, 10 patients with normal post-stenting carotid angiography (< 30% residual stenosis) had peak systolic velocities (PSVs) of the stented internal carotid artery (ICA) of ≤ 155 cm/s and two patients with ≥ 30% residual stenosis had internal carotid artery (ICA) PSVs of > 155 cm/s. Eighty-three patients who underwent carotid stenting as part of clinical trials were analyzed. All patients underwent post-stenting carotid DUS that was done at 1 month and every 6 months thereafter. PSVs and end-diastolic velocities of the ICA and common carotid artery were recorded. Patients with PSVs of the ICA of > 140 cm/s underwent carotid computed tomographic (CT) angiography. The perioperative stroke rate was 1.2%. When the old DUS velocity criteria for nonstented carotid arteries were applied, 54% of patients had ≥ 30% restenosis (PSV of > 120 cm/s), but when our new proposed DUS velocity criteria for stented arteries were applied (PSV of > 155 cm/s), 33% had ≥ 30% restenosis at a mean follow-up of 18 months ( p = .007). The mean PSVs for patients with normal stented carotid arteries based on CT angiography, were 122 cm/s versus 243 cm/s for ≥ 30% restenosis and 113 cm/s versus 230 cm/s for ≥ 30% restenosis based on our new criteria. The mean PSVs of in-stent restenosis of 30 to < 50%, 50 to < 70%, and 70 to 99%, based on CT angiography, were 205 cm/s, 264 cm/s, and 435 cm/s, respectively. Receiver operating curve analysis demonstrated that an ICA PSV of > 155 cm/s was optimal for detecting ≥ 30% in-stent restenosis, with a sensitivity of 100%, a specificity of 90%, a positive predictive value of 74%, and a negative predictive value of 100%. The currently used carotid DUS velocity criteria overestimated the incidence of in-stent restenosis. We propose new velocity criteria for the ICA PSV of > 155 cm/s to define ≥ 30% in-stent restenosis.

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

Abstract WP40: “Good” Angiographic Collateral Circulation Correlates With Lower Dwi Infarct Volumes In Acute Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Dolora Wisco ◽  
Shumei Man ◽  
Ferdinand Hui ◽  
Gabor Toth ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Grading System ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and purpose Large artery occlusion leads to ischemic stroke which volume is influenced by time from symptom onset. This effect is modulated by several factors, including the presence and degree of collateral circulation. We analyze the correlation between a standard angiographic collateral grading system and DWI infarct volumes. Methods We reviewed a prospectively collected retrospective database of ischemic stroke patients admitted between august of 2006 and december of 2011. We included patients with anterior circulation acute ischemic stroke presenting within 8 hours from symptom onset with large vessel occlusion, who underwent pre-treatment MRI and endovascular therapy. DWI infarct volumes were measured by region of interest. ASITN collateral grading system was used and grouped into “good collaterals” for grades 3 and 4, and “poor collaterals” for grades 0, 1 and 2. JMP statistical software was utilized. Results 152 patients (71 (46.7%) male, mean age: 68±15 years;) were included in the initial analysis. We identified 49 patients who had angiographic collateral circulation grading. Seven patients had ASITN collateral grade 0 with mean infarct volume of 27.6 cc, 25 had collateral grade of 1 with mean infarct volume of 27.9 cc, 10 had collateral grade of 2 with mean infarct volume of 23.4 cc, 5 had collateral grade of 3 with mean infarct volume of 6.3 cc, and 2 had collateral grade of 4 with mean infarct volume of 14.6 cc. Forty two patients had “poor collaterals” with a mean infarct volume of 26.8 cc. Seven patients had “good collaterals” with mean infarct volume of 8.7 cc. When comparing the infarct volumes between these two groups, the difference was statistically significant (p=0.017). Conclusions In anterior circulation acute ischemic stroke, “good” angiographic collateral circulation defined as ASITN grading system of 3 or 4, correlates with lower infarct volumes on presentation.

scholarly journals Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

2019 ◽  
Vol 267 (3) ◽  
pp. 649-658 ◽  
Author(s):  
Petrea Frid ◽  
◽  
Mattias Drake ◽  
A. K. Giese ◽  
J. Wasselius ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Small Artery ◽  
Anterior Circulation ◽  
Lesion Location ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Male Sex

Abstract Objective Posterior circulation ischemic stroke (PCiS) constitutes 20–30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Methods Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. Results PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04–1.61; male sex, OR = 1.46; 95% CI 1.21–1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Conclusion Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

WINGSPAN IN-STENT RESTENOSIS AND THROMBOSIS

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 644-651 ◽  
Author(s):  
◽  
Elad I. Levy ◽  
Aquilla S. Turk ◽  
Felipe C. Albuquerque ◽  
David B. Niemann ◽  
...  
Keyword(s):  
Posterior Circulation ◽  
Anterior Circulation ◽  
Target Vessel Revascularization ◽  
Computed Tomographic ◽  
Stent Restenosis ◽  
Current Series ◽  
Complete Thrombosis ◽  
Ischemic Attack ◽  
In Stent Restenosis

Abstract OBJECTIVE Wingspan (Boston Scientific, Fremont, CA) is a self-expanding stent designed specifically for the treatment of symptomatic intracranial atheromatous disease. The current series reports the observed incidence of in-stent restenosis (ISR) and thrombosis on angiographic follow-up. METHODS A prospective, intent-to-treat registry of patients in whom the Wingspan stent system was used to treat symptomatic intracranial atheromatous disease was maintained at five participating institutions. Clinical and angiographic follow-up results were recorded. ISR was defined as stenosis greater than 50% within or immediately adjacent (within 5 mm) to the implanted stents and absolute luminal loss greater than 20%. RESULTS To date, follow-up imaging (average duration, 5.9 mo; range, 1.5–15.5 mo) is available for 84 lesions treated with the Wingspan stent (78 patients). Follow-up examinations consisted of 65 conventional angiograms, 17 computed tomographic angiograms, and two magnetic resonance angiograms. Of these lesions with follow-up, ISR was documented in 25 and complete thrombosis in four. Two of the 4 patients with stent thrombosis had lengthy lesions requiring more than one stent to bridge the diseased segment. ISR was more frequent (odds ratio, 4.7; 95% confidence intervals, 1.4–15.5) within the anterior circulation (42%) than the posterior circulation (13%). Of the 29 patients with ISR or thrombosis, eight were symptomatic (four with stroke, four with transient ischemic attack) and 15 were retreated. Of the retreatments, four were complicated by clinically silent in-stent dissections, two of which required the placement of a second stent. One was complicated by a postprocedural reperfusion hemorrhage. CONCLUSION The ISR rate with the Wingspan stent is higher in our series than previously reported, occurring in 29.7% of patients. ISR was more frequent within the anterior circulation than the posterior circulation. Although typically asymptomatic (76% of patients in our series), ISR can cause neurological symptoms and may require target vessel revascularization.

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.

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