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.

Long-term follow-up of brachytherapy for treatment of allograft in-stent restenosis

2004 ◽  
Vol 61 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Gilbert J. Zoghbi ◽  
Vijay K. Misra ◽  
Gregory D. Chapman ◽  
William B. Hillegass ◽  
Brigitta C. Brott ◽  
...  
Keyword(s):  
Stent Restenosis ◽  
Long Term Follow Up ◽  
In Stent Restenosis

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

Long-term follow-up of patients with sirolimus-eluting stents for treatment of bare-metal in-stent restenosis

2010 ◽  
Vol 140 (2) ◽  
pp. 219-225 ◽  
Author(s):  
Claude Le Feuvre ◽  
Aude Healy-Brucker ◽  
Gérard Helft ◽  
Jacques Monségu ◽  
Olivier Varenne ◽  
...  
Keyword(s):  
Bare Metal ◽  
Stent Restenosis ◽  
Long Term Follow Up ◽  
In Stent Restenosis

scholarly journals Long-term outcomes of the micronet-covered stent system routine use for carotid revsacularization in stroke prevention: PARADIGM-Extend 5 year evidence

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Mazurek ◽  
A Borratynska ◽  
T Tomaszewski ◽  
A Lesniak-Sobelga ◽  
P Wilkolek ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Stroke Risk ◽  
Duplex Ultrasound ◽  
Funding Source ◽  
Stent Restenosis ◽  
Stent System ◽  
System Use ◽  
In Stent Restenosis

Abstract Background Diffusion-weighted magnetic resonance imaging indicates that micronet-covered embolic prevention stent system effectively minimizes peri-procedural and prevents lesion-related post-procedural cerebral embolism in carotid artery stenting but long-term clinical evidence is missing. Purpose To provide long-term clinical and duplex ultrasound evaluation of safety and efficacy of the system use in consecutive carotid revascularization patients. Methods PARADIGM-EXTEND is in all-comer, all-referrals-tracked study with no exclusion criteria other than lack of NeuroVascular Team-determined indication. Clinically asymptomatic patients receive revascularization only in case of increased-stroke-risk characteristics. Adverse events are independently adjudicated. Results Currently 451 patients (48–87 years, 59% symptomatic, 127 women) with 490 arteries crossed the first follow-up window of 30 days. There has been 100% micronet-covered embolic prevention stent system use (ie, no other stent type/s used throughout study). Proximal/distal intra-procedural neuroprotection use was 38.3%/61.7%. Large balloon/high-pressure stent optimization was routine, leading to a single-digit (mean 6.9%) residual diameter stenosis. Independent neurologist and duplex evaluation are before and after revascularization (48h and 30 days, then yearly). Peri-procedural death or major ischemic stroke rate was 0%. One event (prior infarct scar asymptomatic extension in prolonged hypotension course) was adjudicated as minor stroke (0.22%), and there was 1 periprocedural MI (type 2, in 2-vessel non-revascularizable CTO; 0.22%). By 30 days there were no further ischaemic strokes (0%) but there was 1 haemorrhagic transformation that led to death (0.22%) and 1 bleeding-related death (0.22%). Thus total 30-day death/stroke was 0.66%, and total death/stroke/MI was 0.88%. By 60 months there were 3 contralateral, 1 ipsilateral (device-unrelated), and 2 posterior circulation strokes. Baseline internal carotid artery velocities were 3.72±1.25 and 0.63±0.69 m/s (peak-systolic and end-diastolic). Post-procedural in-stent velocities were normal and remained normal throughout the 60-month follow-up period: 0.78±040 and 0.21±0.10 (1y); 0.75±0.36 0.19±0.09 (2y); 0.75±0,35 and 0.21±0.09 (3y); 0.72±0.27 and 0.20±0.07 (4y); 0.79±0.58 and 0.21±0.11m/s (5y). There were 2 in-stent restenoses by 1y (including 1 that occurred with de novo neck radiotherapy) and 1 other by 2y (total 2y in-stent restenosis of 1.1%) but no further ones (0% in-stent restenosis at 2–5y). Conclusions PARADIGM-Extend long-term clinical and duplex ultrasound evidence is consistent with normal healing and sustained safety and stroke prevention efficacy of the micronet-covered embolic prevention stent system used routinely, on top of optimized medical therapy, for stroke prevention in symptomatic and increased-stroke-risk asymptomatic subjects with carotid stenosis recommended for revasularization by the NeuroVascular Team. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Jagiellonian University Medical College

Abstract 2163: Long-term Follow-up (>3 Years) of Patients Treated With Sirolimus-Eluting Stents for In-stent Restenosis. Results of a Randomized Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Fernando Alfonso ◽  
Maria J Perez-Vizcayno ◽  
Armando Bethencourt ◽  
Vicens Martí ◽  
Jose R Lopez-Minguez ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Randomized Study ◽  
Bare Metal Stent ◽  
Long Term Results ◽  
Target Vessel Revascularization ◽  
Angiographic Restenosis ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background: The value of drug-eluting stents in patients (P) with in-stent restenosis (ISR) has been established. However, the long-term results of this strategy in P with ISR remains unknown. Objective: We sought to determine the long-term clinical outcome of P treated with sirolimus-eluting stents (SES) for ISR. Methods: A systematic, pre-specified, long-term clinical follow-up (FU) was performed in all P included in the RIBS II (Restenosis Intra-stent: Balloon angioplasty [BA] vs elective SES implantation) randomized trial. In RIBS II 150 P with ISR after bare-metal stent implantation were included: 74 allocated to BA and 76 to SES. Late angiography was obtained in 96% of eligible P. A structured clinical questionnaire (cardiac/non cardiac death, myocardial infarction [MI], target vessel revascularization [TVR], thrombosis [TH], and medical therapy) was used during FU. Results: Angiographic restenosis (primary end-point) was more frequently found in the BA arm (39% vs 11%, p<0.001). Clinical FU at 1-year was obtained in 150 P (100%). During this time period 6 P died (3 SES, 3 BA), 4 P suffered a MI (2 SES, 2 BA), 2 P experienced TH (1 P in each arm) and 30 required TVR (8 SES, 22 BA, p<0.01). A complete clinical FU >3 years was obtained in 145 P (97%) (mean 38±9 months, median 40 months [IQR 37–42]). Late events (after 1 year, non-exclusive) included: 3 deaths (1 SES, 2 BA), 3 MI (3 SES, 2 due to late TH) and 7 late TVR (5 SES, 2 BA). At 4 years, event-free survival was 76% in the SES arm and 65% in the BA arm (p=0.03). Survival free from TVR at 4 years was 80% in the SES arm and 67% in the BA arm (p=0.02). Conclusion: In P with ISR SES implantation improve the long-term clinical outcome as compared with BA treatment.

Long-Term Clinical Follow-Up after Drug-Eluting Stent Implantation for Bare Metal In-Stent Restenosis

2013 ◽  
Vol 26 (3) ◽  
pp. 271-277
Author(s):  
BALAZS BERTA ◽  
ZOLTAN RUZSA ◽  
GYORGY BARCZI ◽  
DAVID BECKER ◽  
LASZLO GELLER ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Drug Eluting Stent ◽  
Bare Metal ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis
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