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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Risk factors for restenosis after carotid artery angioplasty and stenting
Christopher L Skelly1, Katherine Gallagher, Ronald M Fairman
1Section of Vascular Surgery, University of Chicago Hospitals, Chicago, IL, USA. cskelly@surgery.bsd.uchicago.edu
Insights
Prior neck cancer is a significant risk factor for in-stent restenosis after carotid artery stenting (CAS). Patients with a history of neck cancer experienced substantially higher rates of restenosis compared to those without.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Oncology
Background:
- Carotid artery stenting (CAS) is an increasingly common procedure for managing carotid artery disease.
- Identifying risk factors for in-stent restenosis (ISR) is crucial for optimizing patient outcomes.
- High-risk patients, defined by comorbidities or a hostile neck, often undergo CAS.
Purpose of the Study:
- To identify risk factors associated with the development of in-stent restenosis following carotid artery stenting.
- To evaluate the safety and efficacy of CAS in high-risk patient populations.
Main Methods:
- Retrospective review of 109 CAS procedures performed between 2002 and 2004.
- Analysis of patient demographics, comorbidities, and procedural details.
- Risk factor analysis for in-stent restenosis using univariate and multivariate Cox proportional hazard regression models.
Main Results:
- Prior neck cancer emerged as a marginally significant risk factor for ISR (P = .06) in multivariate analysis.
- Kaplan-Meier analysis showed significantly lower freedom from ISR at 24 months in patients with prior neck cancer (27% ± 17%) compared to those without (88% ± 6%, P = .02).
- Overall complication rates were low, including stroke (0.9%), myocardial infarction (1.9%), and death (0% within 30 days).
Conclusions:
- Carotid artery stenting demonstrates acceptable safety and efficacy, even in high-risk patients.
- A history of neck cancer is a critical factor associated with increased risk of in-stent restenosis after CAS.
- Further investigation into managing ISR in cancer survivors undergoing CAS is warranted.
Objectives:
With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS.
Methods:
Consecutive patients undergoing CAS between January 2002 and October 2004 at a tertiary care hospital were retrospectively reviewed. Patient, filter, and stent selection were left to the discretion of the attending surgeon. High-risk patients were defined by significant comorbidities or a hostile neck (prior surgery or radiation, or both), and risk factor analysis was performed. In-stent restenosis was defined as >60%, and selective angiography was performed on patients with an in-stent restenosis >80% by duplex ultrasound imaging.
Results:
Reviewed were 101 patients (55 men, 46 women) who underwent 109 CAS procedures. Comorbidities were typical for patients with atherosclerosis. In addition, 38% (n = 41) of procedures were performed in patients who had prior neck surgery, of which 29% (n = 32) had previous ipsilateral carotid endarterectomy. Seventeen patients (16%) had a history of neck cancer, and all had prior neck radiation. Median follow-up was 5 months (range, 0 to 30 months). Neurologic complications included three transient ischemic attacks (2.8%) and one nondisabling stroke (0.9%). There were two myocardial infarctions (1.9%) and no periprocedural deaths (30 days), for a combined stroke, myocardial infarction, and death rate of 2.9%. Asymptomatic in-stent restenosis developed in 12 carotids (11%), five of which required endovascular intervention, with a mean of 6 months to restenosis. Univariate Cox proportional hazard regression models were used to determine risk factors for the development of restenosis. Prior stroke, transient ischemic attack, amaurosis fugax, and prior neck cancer were all significant risk factors. When these significant risk factors from univariate analysis were put into multivariate analysis, however, the only marginally significant risk factor was prior neck cancer (P = .06). Kaplan-Meier analysis revealed a cumulative freedom from in-stent restenosis at 24 months of 88% +/- 6% in patients without neck cancer compared with 27% +/- 17% (P = .02) in patients with neck cancer.
Conclusions:
CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.
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