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Cerebral collateral circulation as an independent predictor for in-stent restenosis after carotid artery stenting
Luji Liu1, Xudong Su1, Lihong Zhang1
1Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Insights
Poor cerebral collateral circulation is a key predictor of in-stent restenosis after carotid artery stenting. Maintaining a residual stenosis rate below 12.5% and adhering to standard medication are crucial for prevention.
Area of Science:
- Neuroscience
- Cardiovascular Medicine
- Medical Imaging
Background:
- In-stent restenosis (ISR) poses a significant challenge following carotid artery stenting (CAS).
- Predictors of ISR after CAS remain incompletely understood.
- Cerebral collateral circulation's role in ISR requires further elucidation.
Purpose of the Study:
- To investigate the impact of cerebral collateral circulation on ISR after CAS.
- To develop a clinical prediction model for ISR post-CAS.
Main Methods:
- Retrospective case-control study of 296 patients with severe carotid stenosis undergoing CAS.
- Collateral circulation graded using ASITN/SIR criteria.
- Binary logistic regression analysis to identify ISR predictors and build a nomogram-based prediction model.
Main Results:
- Poor collateral circulation identified as an independent predictor of ISR (P=0.003).
- A 1% increase in residual stenosis rate correlated with a 9% ISR risk increase (P=0.02).
- Ischemic stroke history, family history, prior ISR, and nonstandard medication were also significant predictors.
Conclusions:
- Cerebral collateral status is a critical independent predictor of ISR after successful CAS.
- Residual stenosis rates below 12.5% are associated with reduced ISR risk.
- Adherence to standard post-stenting medication is vital for preventing ISR.
Background:
In-stent restenosis is a crucial problem after carotid artery stenting, but the exact predictors of in-stent restenosis remain unclear. We aimed to evaluate the effect of cerebral collateral circulation on in-stent restenosis after carotid artery stenting and to establish a clinical prediction model for in-stent restenosis.
Methods:
This retrospective case-control study enrolled 296 patients with severe carotid artery stenosis of C1 segment (≥70%) who underwent stent therapy from June 2015 to December 2018. Based on follow-up data, the patients were divided into the in-stent restenosis and no in-stent restenosis groups. The collateral circulation of the brain was graded according to the criteria of the American Society for Interventional and Therapy Neuroradiology/Society for Interventional Radiology (ASITN/SIR). Clinical data were collected, such as age, sex, traditional vascular risk factors, blood cell count, high-sensitivity C-reactive protein, uric acid, stenosis degree before stenting and residual stenosis rate, and medication after stenting. Binary logistic regression analysis was performed to identify potential predictors of in-stent restenosis, and a clinical prediction model for in-stent restenosis after carotid artery stenting was established.
Results:
Binary logistic regression analysis showed that poor collateral circulation was an independent predictor of in-stent restenosis (P=0.003). We also found that a 1% increase in residual stenosis rate was associated with a 9% increase in the risk of in-stent restenosis (P=0.02). Ischemic stroke history (P=0.03), family history of ischemic stroke (P<0.001), in-stent restenosis history (P<0.001), and nonstandard medication after stenting (P=0.04) were predictors of in-stent restenosis. The risk of in-stent restenosis was lowest when the residual stenosis rate was 12.5% after carotid artery stenting. Furthermore, we used some significant parameters to construct a binary logistic regression prediction model for in-stent restenosis after carotid artery stenting in the form of a nomogram.
Conclusions:
Collateral circulation is an independent predictor of in-stent restenosis after successful carotid artery stenting, and the residual stenosis rate tends to be below 12.5% to reduce restenosis risk. The standard medication should be strictly carried out for patients after stenting to prevent in-stent restenosis.
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