Incidence Of Residual Stenosis Research Articles

Risk factors associated with restenosis in patients with percutaneous coronary intervention

ABSTRACT Objective: The objective of this study was to assess the risk factors associated with residual stenosis in patients with percutaneous transluminal coronary angioplasty (PTCA). Materials and Methods: A cross-sectional survey was conducted at a single health-care center among coronary artery disease patients who have undergone PTCA. Primary information including demographics and clinical characteristics, groups of pre- and postdilation balloons, and characteristics of culprits’ vessel flow were retrieved from medical records of each patient. Data were analyzed using descriptive and appropriate comparative statistics. Results: A total of 1000 patients were included in this study. The majority of patients were men (67.0%). Hypertension (HTN) and diabetes were the most common comorbid condition. Yukon Choice phosphorylcholine (PC)-elite (86.2%) was the most common stent used in patients with PTCA followed by Endeavor Sprint (12.7%). All of the patients (100%) underwent PTCA for single culprit vessel disease (SVD) while 30.2% of the patients underwent PTCA for two-vessel disease (2VD). The incidence of residual stenosis was 0.5% for SVD PTCA and 0.3% for 2VD PTCA. The 2VD group achieved thrombolysis in myocardial infarction flow Grade II postrevascularization in 98.6% of patients. Significant associations were observed between residual stenosis and various factors. HTN (odds ratio [OR]: 38.79, 95% confidence interval [CI]: 3.260-461.688; P = 0.004), diabetes mellitus (OR: 4.548, 95% CI: 0.036-63.948; P < 0.001), the use of a 0.014” × 190 cm guide (OR: 185.0, 95% CI: 25.922-1320.294; P < 0.001), and the presence of two-vessel disease (OR: 6.698, 95% CI: 1.221-36.749; P = 0.029) were found to be significantly associated with residual stenosis. Conclusion: Residual stenosis was observed in both SVD and 2VD PTCA however, presence of HTN and DM, and 2VD were identified as pronounced risk factors for residual stenosis.

Risk Factors for Residual Stenosis After Carotid Artery Stenting.

Background and purpose: Stent residual stenosis is an independent risk factor for restenosis after stenting. This study aimed to analyze the factors influencing residual stenosis after carotid artery stenting (CAS).Methods: A total of 570 patients who underwent CAS with 159 closed-loop stents (CLS) and 411 open-loop stents (OLS) from January 2013 to January 2016 were retrospectively enrolled in this study. Carotid stenosis location in the common carotid artery or in internal carotid artery, plaque size, and features (regular or irregular morphology; with or without calcification), degree of carotid artery stenosis, and stent expansion rate were detected by carotid duplex ultrasonography. Residual stenosis was defined as a stenosis rate ≥30% after CAS, as detected by digital subtraction angiography. A logistic regression analysis was used to analyze residual stenosis risk factors.Results: The overall incidence of residual stenosis was 22.8% (130/570 stents). The incidence of residual stenosis in the CLS group was higher than that in the OLS group (29.5 vs. 20.2%, χ2 = 5.71, P = 0.017). The logistic regression analysis showed that CLS [odds ratio (OR), 1.933; 95% confidence interval (CI), 1.009–3.702], irregular plaques (OR, 4.237; 95% CI, 2.391–7.742), and plaques with calcification (OR, 2.370; 95% CI, 1.337–4.199) were independent risk factors for residual stenosis after CAS. In addition, a high radial expansion rate of stent was a protective factor for residual stenosis (OR, 0.171; 95% CI, 0.123–0.238). The stenosis location and stent length did not impact the occurrence of residual stenosis. After 1-year follow-up, the incidence of restenosis in the residual stenosis group was higher than that in the group without residual stenosis (13.1 vs. 2.0%, χ2 = 28.05, P < 0.001).Conclusions: The findings of this study suggest that plaque morphology, echo characteristics (with calcification), and stents type influence residual stenosis.

The correlation of carotid artery structure characteristics and residual stenosis after stenting

Objective To analyze the correlation of characteristics of carotid artery structure and the incidence of residual stenosis after carotid artery stent (CAS) placement and its influencing factors using color Doppler flow imaging (CDFI). Methods Five hundred and ninety-six cases from January 2013 to December 2015 who underwent CAS (600 pieces of stent) were included in this study. All patients were examined by CDFI within 1 month before and 1 week after carotid artery stenting. The incidence of residual stenosis was analysed. The correlation of residual stenosis and the characteristics of carotid artery lesions and atherosclerotic plaque before stenting were analyzed respectively. Results There was positive correlation between the incidence rates of residual stenosis and irregularly shaped plaque (odd ratios, 9.02; 95% confidence interval, 5.21-15.59, P<0.05), the plaques with calcification in the surface(odd ratios, 2.55; 95% confidence interval, 1.45-4.49, P<0.05), the residual diameter of carotid stenosis less than 1.0 mm(odd ratios, 1.61; 95% confidence interval, 1.06-2.45, P<0.05), which were the independent risk factors for influencing residual stenosis after CAS. Conclusions Choosing a more adaptable stent based on the characteristics of carotid artery lesions and atherosclerotic plaque by CDFI before stenting may be useful for the patients to get best result of revascularization. The rate of residual stenosis may be decreased. Key words: Ultrasonography, Doppler, color; Carotid stenosis; Residual stenosis; Rish factors

First impressions are good, but appearances can be deceptive!

We want the facts to fit the preconceptions. When they do not, it is easier to ignore the facts than change the preconceptions. Jessamyn West (1902–84)Zahn et al . publish the latest analyses from the Carotid Artery Stent (CAS) Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausartzte (ALKK) of Germany.1 This reports outcomes following CAS in octogenarians ( n = 321) compared with younger patients ( n = 2557). As indicated in the introduction, this analysis was prompted by conflicting published data regarding the safety of CAS in elderly patients. Having reviewed their experience, the authors conclude that ‘the in-hospital stroke or death rate does increase significantly with older age; however, there was no excess complication rate in octogenarians’. Is this conclusion valid and how should the ALKK findings influence practice? Notwithstanding the marked disparity in numbers between the two groups, the ALKK Registry make a number of important observations in patients aged > 80 years undergoing CAS. (i)The case volume (proportional to the total annual workload) is increasing rapidly (6% in 1996 vs. 14% in 2005). (ii) CAS took longer to perform (45 vs. 40 min, P = 0.008). (iii) CAS was associated with a higher incidence of residual stenosis at the end of the procedure (10 vs. 5%, P = 0.006). (iv) CAS was more frequently aborted in patients aged > 80 years (7 vs. 2%, P < 0.001). (v) Elderly patients were less likely to undergo CAS while receiving statin therapy (71 vs. 84%, P < 0.001). (vi) Elderly CAS patients faced no excess risk of access complications (2.5 vs. 1.3%, P = 0.13). (vii) Octogenarian CAS patients did face a significantly higher in-hospital death/stroke rate (5.5 vs. 3.2% P = 0.032). (viii) Not surprisingly, octogenarian CAS patients encountered a significantly higher in-hospital rate of death/stroke and TIA (11 … Corresponding author. Tel: +44 116 2523252; fax: +44 116 2523179. E-mail address : ross.naylor{at}uhl-tr.nhs.uk

The Role of Intraoperative Digital Subtraction Angiography for Quality Control of Standard Carotid Endarterectomy Using Patch Angioplasty

The absence of technical defects is considered to be of great importance during carotid endarterectomy (CEA). In this context, both safe surgical technique and intraoperative quality control may be a fundamental part of the operative procedure. We have therefore undertaken a prospective study to evaluate the possible benefits of completion angiography in standard CEA using patch angioplasty. The objectives were three-fold: (1) to identify the incidence of defects requiring prompt revision; (2) to assess the perioperative stroke rate as well as the number of residual stenosis after 6 weeks in angiographically controlled patients and (3) to compare these results with a control group. From 1 January to 30 September 1999 111 patients with 115 consecutive CEAs which had completion angiography (Group A) were prospectively entered into this study. The results in group A were compared with a series of again 111 patients (Group B) which had 116 CEAs without intraoperative quality control between January and September in the year before. Surgical technique was identical in both groups. In general, risk factors were distributed evenly among both group with the exception that in group A were significantly more high-grade ipsilateral ICA stenoses while group B had more patients with diabetes and ipsilateral CT-defects. In group A, angiographic irregularities prompted us to immediate re-exploration in five patients (dilatation of severe ICA spasm 1; re-exploration of distal ICA occlusion 1; reopening of occluded ECA 3). With a 30 day mortality of 0% each perioperative stroke rate was comparable with 3/115 in group A and 3/116 in group B ( P = 1.0). 2/3 patients with neurological deficits in group A had early postoperative carotid thrombosis — in spite of a normal completion study. Duplex examination after 6 weeks revealed one asymptomatic ICA occlusion in each group. The incidence of residual stenosis (≥50%) was not significantly different being 3.7% in group A and 3.2% in group B ( P= 0.85). When applying a safe and simple operative technique for CEA, the incidence of abnormalities warranting immediate correction appears to be a rare event and, therefore, the necessity for obligatory quality control may be questionable. On the other hand, completion DSA allows a simple documentation of the adequacy of the surgical procedure.

The role of intraoperative digital subtraction angiography for quality control of standard carotid endarterectomy using patch angioplasty

The absence of technical defects is considered to be of great importance during carotid endarterectomy (CEA). In this context, both safe surgical technique and intraoperative quality control may be a fundamental part of the operative procedure. We have therefore undertaken a prospective study to evaluate the possible benefits of completion angiography in standard CEA using patch angioplasty. The objectives were three-fold: (1) to identify the incidence of defects requiring prompt revision; (2) to assess the perioperative stroke rate as well as the number of residual stenosis after 6 weeks in angiographically controlled patients and (3) to compare these results with a control group. From 1 January to 30 September 1999 111 patients with 115 consecutive CEAs which had completion angiography (Group A) were prospectively entered into this study. The results in group A were compared with a series of again 111 patients (Group B) which had 116 CEAs without intraoperative quality control between January and September in the year before. Surgical technique was identical in both groups. In general, risk factors were distributed evenly among both group with the exception that in group A were significantly more high-grade ipsilateral ICA stenoses while group B had more patients with diabetes and ipsilateral CT-defects. In group A, angiographic irregularities prompted us to immediate re-exploration in five patients (dilatation of severe ICA spasm 1; re-exploration of distal ICA occlusion 1; reopening of occluded ECA 3). With a 30 day mortality of 0% each perioperative stroke rate was comparable with 3/115 in group A and 3/116 in group B ( P=1.0). 2/3 patients with neurological deficits in group A had early postoperative carotid thrombosis — in spite of a normal completion study. Duplex examination after 6 weeks revealed one asymptomatic ICA occlusion in each group. The incidence of residual stenosis (≥50%) was not significantly different being 3.7% in group A and 3.2% in group B ( P=0.85). When applying a safe and simple operative technique for CEA, the incidence of abnormalities warranting immediate correction appears to be a rare event and, therefore, the necessity for obligatory quality control may be questionable. On the other hand, completion DSA allows a simple documentation of the adequacy of the surgical procedure.

Surgical Experience with Doty's Repair for Supravalvular Aortic Stenosis

The surgical treatment of severe supravalvular aortic stenosis by conventional, asymmetrical, one point patch aortoplasty across the narrowed area has been associated with a substantial incidence of residual stenosis and reoperations. Almost symmetrical relief of such stenosis was achieved with Doty's extended aortoplasty in 5 patients in whom left ventricular aortic gradient was reduced from 60–170 nun Hg to 0–25 mm Hg. This technique of inserting an inverted V-shaped gusset across the stenosed segment into the right coronary sinus and non-coronary sinus, restores the aortic root geometry, provides more predictable relief of aortic obstruction and also improves aortic valve function. Associated procedures involved relief of coarctation of aorta and innominate artery stenosis in 1 case and repair of aortic valve and mitral valve in another case.