Abstract

BackgroundIn-stent restenosis (ISR) is an important factor endangering the long-term safety and efficacy of carotid artery angioplasty and stenting (CAS). It is plausible that soft vulnerable plaques are more likely to be injured during CAS procedure and are therefore more likely to initiate the cascade finally leading to ISR. The aim of this study was to investigate if plaque morphology detected by a simple applicable Duplex ultrasound score before CAS can be used as a predictor for ISR.MethodsWithin a prospectively collected single-centre CAS database of 281 patients (comprising 300 arteries) with high-grade carotid artery stenosis, who underwent CAS between May 2003 and January 2013, we conducted a nested case–control study. Plaque morphology before CAS was analysed by a blinded investigator and each parameter of the Total Plaque Risk Score (TPRS) as well as the whole score was evaluated with regard to its diagnostic validity for ISR.ResultsWe analysed the data of 10 patients with ISR and 50 patients without ISR. There were no significant differences with respect to baseline characteristics, vascular risk factors, and degree of stenosis between patients with and without ISR. The duration of follow-up was longer in patients with ISR (p = 0.024) and these patients were more likely to show increased PSV (p = 0.012) immediately after CAS than patients without ISR. Neither individual parameters of the TPRS score nor the score as a whole were suitable as a diagnostic test for ISR development.ConclusionsIn the present study we could demonstrate that the non-contrast enhanced DUS of the pre-interventional plaque formation cannot be used as a predictor for the development of ISR. Evaluating a more sophisticated, but not routinely available approach e.g. by ultrasound based plaque perfusion imaging or CT based plaque analysis could be helpful in the future in order to assess the role of plaque morphology in the context of ISR development.

Highlights

  • In-stent restenosis (ISR) is an important factor endangering the long-term safety and efficacy of carotid artery angioplasty and stenting (CAS)

  • One factor that could influence the long-term safety and efficacy of CAS is an in-stent restenosis (ISR); we could recently show that the combined stroke and death rate during long-term follow-up was significantly higher in the group of patients suffering from ISR compared with patients without ISR [12]

  • A total of sixty patients (48 men and 12 women) treated with CAS were analyzed in this study including 10 cases and 50 controls without ISR

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Summary

Introduction

In-stent restenosis (ISR) is an important factor endangering the long-term safety and efficacy of carotid artery angioplasty and stenting (CAS). Atherosclerotic stenosis of the internal carotid artery (ICA) is known as a major risk factor for disabling stroke and death. One factor that could influence the long-term safety and efficacy of CAS is an in-stent restenosis (ISR); we could recently show that the combined stroke and death rate during long-term follow-up was significantly higher in the group of patients suffering from ISR compared with patients without ISR [12]. Up to now it could be shown that (regardless of a CAS intervention) a compound score of plaque surface irregularity, echoluency and texture characteristics can predict the risk of stroke [13]. It could be shown that fibrolipid plaques are associated with a higher burden of new ischemic lesions [14,15]

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