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Updated: Jun 15, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Risk factors of in-stent restenosis after carotid angioplasty and stenting: long-term follow-up study
Sangil Park1,2, Bum Joon Kim3, Hye-Yeon Choi4,5
1Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea.
Insights
Current smoking and elevated baseline internal carotid artery peak systolic velocity are key risk factors for in-stent restenosis after carotid artery stenting. Asymptomatic patients had better outcomes, with no restenosis observed after 39 months.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Carotid artery angioplasty with stenting (CAS) is a common procedure for carotid artery stenosis.
- Long-term outcomes after CAS, particularly in-stent restenosis (ISR), require further investigation.
- Identifying risk factors for ISR is crucial for improving patient management.
Purpose of the Study:
- To assess factors associated with long-term in-stent restenosis (ISR) after carotid artery angioplasty with stenting (CAS).
- To evaluate the relationship between baseline characteristics and ISR development.
- To compare ISR rates between symptomatic and asymptomatic patients undergoing CAS.
Main Methods:
- Retrospective analysis of 189 patients who underwent CAS between 2013 and 2018.
- Carotid Doppler ultrasonography (CDU) used for follow-up, defining restenosis by specific peak systolic velocity (PSV) criteria.
- Kaplan-Meier analysis and multivariable regression to identify independent risk factors for ISR.
Main Results:
- ISR was independently associated with current smoking and elevated baseline internal carotid artery (ICA) peak systolic velocity (PSV).
- In symptomatic patients, alcohol consumption was also an independent risk factor for ISR.
- ISR-free rates were better in the asymptomatic CAS group, with no ISR occurring after 39 months.
Conclusions:
- Current smoking and elevated baseline ICA PSV are significant independent risk factors for ISR following CAS.
- Alcohol consumption is an independent risk factor for ISR in symptomatic CAS patients.
- Further long-term studies are warranted to fully elucidate the outcomes of CAS.
Background:
After carotid artery angioplasty with stenting (CAS), it is unclear which risk factors are related to long-term outcomes, including in-stent restenosis (ISR). This study aimed to assess the factors associated with restenosis after CAS with a median follow-up of 35.7 months.
Materials And Methods:
Patients who underwent CAS from January 2013 to December 2018 were included if they had symptomatic or asymptomatic carotid artery stenosis. The carotid Doppler ultrasonography (CDU) was followed up after the procedure. We defined at least 50% restenosis using the criteria that the internal carotid artery (ICA) peak systolic velocity (PSV) was greater than 224 cm/s or the ICA to common carotid artery PSV ratio was higher than 3.4. The risk factors for ISR were also assessed.
Results:
Of the 189 patients, 122 had symptomatic carotid artery stenosis, and 67 had asymptomatic carotid artery stenosis. Patients were evaluated by CDU for a median of 35.7 months (interquartile range 19.5 to 70.0). Kaplan-Meier analysis showed that the longest time to ISR was 39 months, and ISR-free was better in the asymptomatic CAS group. In all groups, ISR was independently associated with current smoker [adjusted odds ratio (aOR), 3.425; 95% confidence interval (CI), 1.086 to 10.801] and elevated ICA PSV at baseline (aOR, 1.004; 95% CI, 1.001 to 1.007).
Conclusion:
Independent risk factors for ISR in the CAS group included current smoking and elevated ICA PSV at baseline. In the symptomatic CAS group, alcohol was independently associated with the ISR. ISR did not occur after 39 months from the CAS procedure in our study patients. Future studies with extended follow-up are necessary to fully understand the long-term outcomes of CAS.
