Residual stenosis after carotid artery stenting: Effect on periprocedural and long-term outcomes.

Jihoon Kang,Ji Sung Lee,Moon-Ku Han,Beom Joon Kim,Chang Wan Oh,O-Ki Kwon,Cheolkyu Jung,Hee-Joon Bae,Jeong-Ho Hong,Rudolf Kirchmair

doi:10.1371/journal.pone.0216592

Abstract

ObjectiveThis study investigated the effect of residual stenosis after carotid artery stenting (CAS) on periprocedural and long-term outcomes.MethodsPatients treated with CAS for symptomatic or asymptomatic carotid arterial stenosis were consecutively enrolled. Residual stenosis was estimated from post-procedure angiography findings. The effects of residual stenosis on 30-day periprocedural outcome and times to restenosis and clinical outcome were analyzed using logistic regression models and Wei-Lin-Weissfeld models, respectively.ResultsA total of 412 patients (age, 64.7 ± 17.0 years; male, 82.0%) were enrolled. The median baseline stenosis was 80% (interquartile range [IQR], 70–90%), which improved to 10% (0–30%) for residual stenosis. Residual stenosis was significantly associated with periprocedural outcome (adjusted odds ratio, 0.983; 95% confidence interval [CI], 0.965–0.999, P = 0.01) after adjustment for baseline stenosis, age, hypertension, symptomaticity, and statin use. Over the 5-year observation period, residual stenosis did not increase the global hazard for restenosis and clinical outcome (adjusted hazard ratio, 1.011; 95% CI, 0.997–1.025. In the event-specific model, residual stenosis increased the hazard for restenosis (adjusted hazard ratio, 1.041; 1.012–1.072) but not for clinical outcome (adjusted hazard ratio, 1.011; 0.997–1.025).ConclusionsResidual stenosis after carotid artery stenting may be useful to predict periprocedural outcome and restenosis.

Highlights

Carotid artery stenting (CAS) has become the first line therapeutic option for managing patients with significant carotid stenosis.[1,2,3] As like the previous standard and effective therapeutic strategy of carotid endarterectomy (CEA), CAS has been shown to decrease the longterm cardiovascular risk to approximately 1% per year.[1,2]A major concern associated with CAS is its 3–7% rate of periprocedural adverse outcomes, which is generally higher than that of CEA.[4]
The median baseline stenosis was 80%, which improved to 10% (0– 30%) for residual stenosis
Residual stenosis was significantly associated with periprocedural outcome after adjustment for baseline stenosis, age, hypertension, symptomaticity, and statin use