Restenosis Predictors after Carotid Angioplasty and Stenting and Its Influence on Procedure Durability, Single-Center Experience

Abstract

This article reports our experience regarding in-stent restenosis in the carotid arteries with special focus was given to angiographic morphology and clinical predictors of in-stent restenosis. Between July 2008 and August 2011, 245 carotid angioplasty and stenting procedures were performed in 243 patients (172 men and 71 women). Stenting for de novo stenoses was performed in 214 (87.3%) carotid arteries, and 31 (12.7%) vessels were treated because of postsurgical restenosis. Symptomatic lesions were detected in 187 patients (76.3%). Angiography confirmed any significant recurrent lesion detected on the ultrasound scan. Symptomatic or significant (70%) recurrent lesions detected on the ultrasound scan were an indication for retreatment. During the follow-up period of 821 days (range: 62-1750 days), there were 10 deaths, all non-procedure related. Stent restenosis was defined as greater than 30% narrowing of the vessel lumen diameter and could be detected in 35 (14.3%) patients. Retreatment was indicated in 16 (6.5%) patients. Three types of restenosis were differentiated: tandem type restenosis (n = 5 of 35); "in-stent" restenosis (n = 18 of 35); and "end-stent" restenosis (n = 12 of 35). Interventions, either dilation alone (n = 12) or dilation with restenting (n = 4) for restenosis, were performed with 1 procedure-related dysphasia that resolved in 30 days. Female gender, hypercholesterolemia, peripheral vascular disease (PVD), initial stenosis, and surgical graft were predictors of target lesion revascularization. In our cohort, history of surgical endarterectomy, female gender, hypercholesterolemia, PVD, and initial stenosis were predictors of in-stent restenosis. Three types of restenosis were identified in our cohort.