The myth of restenosis after carotid angioplasty and stenting

Karam Moon, Felipe C. Albuquerque, Michael R. Levitt, Azam S. Ahmed, M. Yashar S. Kalani, Cameron McDougall

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Reported 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.

METHODS: Demographic, 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.

RESULTS: The 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).

CONCLUSIONS: Restenosis 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.

Original languageEnglish (US)
Pages (from-to)1006-1010
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Angioplasty
Neck
Stents
Carotid Arteries
Carotid Artery Injuries
Laryngeal Nerves
Paralysis
Comorbidity
Pathologic Constriction
Stroke
Demography
Incidence

Keywords

  • Angiography
  • Angioplasty
  • Plaque
  • Stent
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The myth of restenosis after carotid angioplasty and stenting. / Moon, Karam; Albuquerque, Felipe C.; Levitt, Michael R.; Ahmed, Azam S.; Kalani, M. Yashar S.; McDougall, Cameron.

In: Journal of NeuroInterventional Surgery, Vol. 8, No. 10, 01.10.2016, p. 1006-1010.

Research output: Contribution to journalArticle

Moon, Karam ; Albuquerque, Felipe C. ; Levitt, Michael R. ; Ahmed, Azam S. ; Kalani, M. Yashar S. ; McDougall, Cameron. / The myth of restenosis after carotid angioplasty and stenting. In: Journal of NeuroInterventional Surgery. 2016 ; Vol. 8, No. 10. pp. 1006-1010.
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abstract = "BACKGROUND AND PURPOSE: Reported 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.METHODS: Demographic, 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.RESULTS: The 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).CONCLUSIONS: Restenosis 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.",
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AU - Moon, Karam

AU - Albuquerque, Felipe C.

AU - Levitt, Michael R.

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AU - Kalani, M. Yashar S.

AU - McDougall, Cameron

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N2 - BACKGROUND AND PURPOSE: Reported 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.METHODS: Demographic, 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.RESULTS: The 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).CONCLUSIONS: Restenosis 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.

AB - BACKGROUND AND PURPOSE: Reported 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.METHODS: Demographic, 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.RESULTS: The 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).CONCLUSIONS: Restenosis 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.

KW - Angiography

KW - Angioplasty

KW - Plaque

KW - Stent

KW - Stroke

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