Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study
Purpose: To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience. Methods: Between December 20...
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| Veröffentlicht in: | Journal of endovascular therapy 2003-12, Vol.10 (6), p.1031-1038 |
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| creator | Setacci, Carlo Pula, Giorgio Baldi, Irene de Donato, Giammarco Setacci, Francesco Cappelli, Alessandro Pieraccini, Massimo Cremonesi, Alberto Castriota, Fausto Neri, Eugenio |
| description | Purpose:
To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience.
Methods:
Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2–72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan.
Results:
Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0–27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks).
In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p = 0.001) in this cohort.
Conclusions:
The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure. |
| doi_str_mv | 10.1177/152660280301000602 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71512042</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_152660280301000602</sage_id><sourcerecordid>71512042</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2522-c1837f4eaa8427c371babfa1fc9cea63bcfd5871918d79fe6ff3e2dea6bb6d113</originalsourceid><addsrcrecordid>eNp9kE9LAzEQxYMotla_gAfJydvaTLLZbL2V-q9QEKyel2w2KVt2k5pkD_32prTgQfA0j5nfPGYeQrdAHgCEmAKnRUFoSRgBQkiSZ2gMPOcZcE7OD5oW2YEYoasQtoRQoACXaAS5oIwLNkbrJx2171srbQzYGby02TpqG_GHDqm60AYsTWLwQnoX2wbP7aZ1u06GuH_E89QOOls4G73r8DoOzf4aXRjZBX1zqhP09fL8uXjLVu-vy8V8lSnKKc0UlEyYXEtZ5lQoJqCWtZFg1ExpWbBamYaXAmZQNmJmdGEM07RJo7ouGgA2QfdH351330M6t-rboHTXSavdECoBHCjJaQLpEVTeheC1qXa-7aXfV0CqQ5TV3yjT0t3Jfah73fyunLJLwPQIBLnR1dYN3qZv_7P8AVABfCI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>71512042</pqid></control><display><type>article</type><title>Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study</title><source>Access via SAGE</source><source>MEDLINE</source><creator>Setacci, Carlo ; Pula, Giorgio ; Baldi, Irene ; de Donato, Giammarco ; Setacci, Francesco ; Cappelli, Alessandro ; Pieraccini, Massimo ; Cremonesi, Alberto ; Castriota, Fausto ; Neri, Eugenio</creator><creatorcontrib>Setacci, Carlo ; Pula, Giorgio ; Baldi, Irene ; de Donato, Giammarco ; Setacci, Francesco ; Cappelli, Alessandro ; Pieraccini, Massimo ; Cremonesi, Alberto ; Castriota, Fausto ; Neri, Eugenio</creatorcontrib><description>Purpose:
To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience.
Methods:
Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2–72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan.
Results:
Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0–27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks).
In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p = 0.001) in this cohort.
Conclusions:
The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure.</description><identifier>ISSN: 1526-6028</identifier><identifier>EISSN: 1545-1550</identifier><identifier>DOI: 10.1177/152660280301000602</identifier><identifier>PMID: 14723573</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Angioplasty, Balloon - adverse effects ; Angioplasty, Balloon - methods ; Carotid Stenosis - diagnosis ; Carotid Stenosis - surgery ; Carotid Stenosis - therapy ; Case-Control Studies ; Confidence Intervals ; Endarterectomy, Carotid - adverse effects ; Endarterectomy, Carotid - methods ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Risk Assessment ; Stents - adverse effects ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of endovascular therapy, 2003-12, Vol.10 (6), p.1031-1038</ispartof><rights>2003 SAGE Publications</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2522-c1837f4eaa8427c371babfa1fc9cea63bcfd5871918d79fe6ff3e2dea6bb6d113</citedby><cites>FETCH-LOGICAL-c2522-c1837f4eaa8427c371babfa1fc9cea63bcfd5871918d79fe6ff3e2dea6bb6d113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/152660280301000602$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/152660280301000602$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14723573$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Setacci, Carlo</creatorcontrib><creatorcontrib>Pula, Giorgio</creatorcontrib><creatorcontrib>Baldi, Irene</creatorcontrib><creatorcontrib>de Donato, Giammarco</creatorcontrib><creatorcontrib>Setacci, Francesco</creatorcontrib><creatorcontrib>Cappelli, Alessandro</creatorcontrib><creatorcontrib>Pieraccini, Massimo</creatorcontrib><creatorcontrib>Cremonesi, Alberto</creatorcontrib><creatorcontrib>Castriota, Fausto</creatorcontrib><creatorcontrib>Neri, Eugenio</creatorcontrib><title>Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study</title><title>Journal of endovascular therapy</title><addtitle>J Endovasc Ther</addtitle><description>Purpose:
To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience.
Methods:
Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2–72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan.
Results:
Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0–27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks).
In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p = 0.001) in this cohort.
Conclusions:
The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure.</description><subject>Aged</subject><subject>Angioplasty, Balloon - adverse effects</subject><subject>Angioplasty, Balloon - methods</subject><subject>Carotid Stenosis - diagnosis</subject><subject>Carotid Stenosis - surgery</subject><subject>Carotid Stenosis - therapy</subject><subject>Case-Control Studies</subject><subject>Confidence Intervals</subject><subject>Endarterectomy, Carotid - adverse effects</subject><subject>Endarterectomy, Carotid - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Stents - adverse effects</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>1526-6028</issn><issn>1545-1550</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LAzEQxYMotla_gAfJydvaTLLZbL2V-q9QEKyel2w2KVt2k5pkD_32prTgQfA0j5nfPGYeQrdAHgCEmAKnRUFoSRgBQkiSZ2gMPOcZcE7OD5oW2YEYoasQtoRQoACXaAS5oIwLNkbrJx2171srbQzYGby02TpqG_GHDqm60AYsTWLwQnoX2wbP7aZ1u06GuH_E89QOOls4G73r8DoOzf4aXRjZBX1zqhP09fL8uXjLVu-vy8V8lSnKKc0UlEyYXEtZ5lQoJqCWtZFg1ExpWbBamYaXAmZQNmJmdGEM07RJo7ouGgA2QfdH351330M6t-rboHTXSavdECoBHCjJaQLpEVTeheC1qXa-7aXfV0CqQ5TV3yjT0t3Jfah73fyunLJLwPQIBLnR1dYN3qZv_7P8AVABfCI</recordid><startdate>200312</startdate><enddate>200312</enddate><creator>Setacci, Carlo</creator><creator>Pula, Giorgio</creator><creator>Baldi, Irene</creator><creator>de Donato, Giammarco</creator><creator>Setacci, Francesco</creator><creator>Cappelli, Alessandro</creator><creator>Pieraccini, Massimo</creator><creator>Cremonesi, Alberto</creator><creator>Castriota, Fausto</creator><creator>Neri, Eugenio</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200312</creationdate><title>Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study</title><author>Setacci, Carlo ; Pula, Giorgio ; Baldi, Irene ; de Donato, Giammarco ; Setacci, Francesco ; Cappelli, Alessandro ; Pieraccini, Massimo ; Cremonesi, Alberto ; Castriota, Fausto ; Neri, Eugenio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2522-c1837f4eaa8427c371babfa1fc9cea63bcfd5871918d79fe6ff3e2dea6bb6d113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon - adverse effects</topic><topic>Angioplasty, Balloon - methods</topic><topic>Carotid Stenosis - diagnosis</topic><topic>Carotid Stenosis - surgery</topic><topic>Carotid Stenosis - therapy</topic><topic>Case-Control Studies</topic><topic>Confidence Intervals</topic><topic>Endarterectomy, Carotid - adverse effects</topic><topic>Endarterectomy, Carotid - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Stents - adverse effects</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Setacci, Carlo</creatorcontrib><creatorcontrib>Pula, Giorgio</creatorcontrib><creatorcontrib>Baldi, Irene</creatorcontrib><creatorcontrib>de Donato, Giammarco</creatorcontrib><creatorcontrib>Setacci, Francesco</creatorcontrib><creatorcontrib>Cappelli, Alessandro</creatorcontrib><creatorcontrib>Pieraccini, Massimo</creatorcontrib><creatorcontrib>Cremonesi, Alberto</creatorcontrib><creatorcontrib>Castriota, Fausto</creatorcontrib><creatorcontrib>Neri, Eugenio</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of endovascular therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Setacci, Carlo</au><au>Pula, Giorgio</au><au>Baldi, Irene</au><au>de Donato, Giammarco</au><au>Setacci, Francesco</au><au>Cappelli, Alessandro</au><au>Pieraccini, Massimo</au><au>Cremonesi, Alberto</au><au>Castriota, Fausto</au><au>Neri, Eugenio</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study</atitle><jtitle>Journal of endovascular therapy</jtitle><addtitle>J Endovasc Ther</addtitle><date>2003-12</date><risdate>2003</risdate><volume>10</volume><issue>6</issue><spage>1031</spage><epage>1038</epage><pages>1031-1038</pages><issn>1526-6028</issn><eissn>1545-1550</eissn><abstract>Purpose:
To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience.
Methods:
Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2–72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan.
Results:
Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0–27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks).
In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p = 0.001) in this cohort.
Conclusions:
The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>14723573</pmid><doi>10.1177/152660280301000602</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Angioplasty, Balloon - adverse effects Angioplasty, Balloon - methods Carotid Stenosis - diagnosis Carotid Stenosis - surgery Carotid Stenosis - therapy Case-Control Studies Confidence Intervals Endarterectomy, Carotid - adverse effects Endarterectomy, Carotid - methods Female Humans Male Middle Aged Odds Ratio Prognosis Proportional Hazards Models Recurrence Retrospective Studies Risk Assessment Stents - adverse effects Survival Rate Treatment Outcome |
| title | Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study |
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