Frequency and consequences of early in-stent lesions after carotid artery stent placement
Lisa M Jongen1, Jeroen Hendrikse, Annet Waaijer
1Department of Radiology, University Medical Center Utrecht, Heidelberglaan, The Netherlands. L.Jongen@umcutrecht.nl
Insights
In-stent lesions after carotid artery stenting occur in about 20% of patients one month post-procedure. These early lesions do not increase the risk of stroke or restenosis within one year.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Carotid artery stenosis is a significant risk factor for ischemic stroke.
- Carotid artery stenting (CAS) is an alternative to endarterectomy for treating symptomatic stenosis.
- In-stent lesions can occur after CAS, but their clinical significance is not fully understood.
Purpose of the Study:
- To determine the prevalence of in-stent lesions one month after CAS using multidetector CT angiography.
- To investigate the causes and consequences of these early in-stent lesions over a one-year follow-up period.
Main Methods:
- Sixty-nine patients with symptomatic carotid artery stenosis underwent CAS.
- Multidetector CT angiography was performed one month post-stenting to identify in-stent lesions.
- Patients were followed for one year, with duplex ultrasonography used to assess restenosis.
Main Results:
- In-stent lesions were detected in 14% of patients (20%) at one month.
- One stent was occluded; other lesions did not cause significant lumen reduction.
- No significant difference in ischemic events or restenosis at one year was observed between patients with and without early in-stent lesions.
Conclusions:
- In-stent lesions are common one month after CAS, found in approximately one-fifth of patients.
- These early lesions do not appear to be associated with an increased risk of recurrent ischemic events or restenosis at one year.
Purpose:
To examine the prevalence of in-stent lesions 1 month after carotid artery stent placement with multidetector computed tomography (CT) angiography and to evaluate their possible causes and their consequences during 1-year follow-up.
Materials And Methods:
Sixty-nine patients with symptomatic carotid artery stenosis underwent multidetector CT angiography of the carotid arteries 1 month after carotid artery stent placement. Patients were followed-up until 1 year after stent placement, when duplex ultrasonography (US) was performed. In-stent lesions were defined as hypo- or hyperattenuating lesions at the stent wall found with multidetector CT. Significant restenosis (70%) at 1 year was defined as a peak systolic velocity of more than 300 cm/sec at duplex US. The Fisher exact test was used to assess the relationship between early in-stent lesions and ischemic events and restenosis.
Results:
At 1 month, 14 of the 69 patients (20%) were found to have in-stent lesions. In one patient, the stent was occluded. The other 13 in-stent lesions did not result in significant lumen reduction. In the year following stent placement, no difference in ischemic events was found between patients with (14%) and those without (13%) early in-stent lesions (P = .99). There was no difference in the occurrence of restenosis at 1 year (7% vs 4%, P = .59).
Conclusions:
At 1 month after carotid artery stent placement, in-stent lesions are found in about one-fifth of patients. These lesions do not appear to be related to recurrent ischemic events or to restenosis at 1 year.
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