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Restenosis After Carotid Angioplasty and Stenting
Study Questions:
What are the predictors and implications of restenosis in patients undergoing carotid angioplasty and stenting?
Methods:
The authors studied 1,060 consecutive patients with carotid stenosis treated with angioplasty at a single University Hospital between 2002 and 2013. Restenosis was defined as a narrowing of ≥70% of a previously treated vessel evaluated by ultrasonography.
Results:
Of the 1,060 patients treated, 9.2% (97) of patients experienced restenosis during follow-up (median 12 [9–32] months). Occurrence of restenosis was associated with ipsilateral stroke during follow-up (9% vs. 3%, p = 0.049). Independent predictors of restenosis were hypertension (hazard ratio [HR], 6.2; 95% confidence interval [CI], 1.9-19.9; p = 0.002), impaired vasoreactivity (HR, 1.7; 95% CI, 1.09-2.8; p = 0.019), and angioplasty without stent (HR, 2.9; 95% CI, 1.2-6.8; p = 0.012).
Conclusions:
Carotid restenosis was associated with an increased risk of long-term stroke in this population of patients treated with carotid angioplasty or stenting.
Perspective:
Most contemporary randomized trials of carotid stenting have demonstrated a restenosis rate of 5-6% and patients with in-stent restenosis have generally demonstrated a good outcome. The results of this study might be explained in part by the inclusion of patients who were treated without stents (or with angioplasty only) in whom prior studies have also demonstrated an increased risk of restenosis as well as subsequent increased risk of ischemic events in association with restenosis (McCabe, Stroke 2005).
Keywords: Angioplasty, Carotid Stenosis, Coronary Restenosis, Hospitals, University, Hypertension, Risk, Stents, Stroke, Ultrasonography, Vascular Diseases
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