Skip to main content
SpringerLink
Log in

Factors affecting long-term restenosis after carotid stenting for carotid atherosclerotic disease

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

The most significant factors leading to restenosis are yet to be described in the literature. The purpose of our study was to identify the incidence of restenosis in our patients with carotid artery stenting (CAS) for carotid atherosclerotic disease and to identify risk factors that are significantly responsible or related to the restenosis.

Methods

In this retrospective analysis of patients who underwent CAS for atherosclerotic disease between years 2002 and 2006, we studied various demographic, clinical, and medical factors, plaque characteristics, and technical aspects of CAS. All patients were followed up with carotid Doppler ultrasound at baseline (after 2 to 4 weeks of CAS) and then with Doppler ultrasound and clinically for various intervals of time. The restenosis was classified based on carotid Doppler ultrasound results. Clinically, restenosis was classified as symptomatic or asymptomatic. Pearson correlation coefficient was used to assess the statistical correlation of the different factors with the incidence of restenosis.

Results

We had a total of 105 patients, with a total of 204.6 patient-year follow-up (mean, 1.95 years; range, 0–7.3 years). The overall incidence of restenosis was 26.7 % (n = 28): mild, 7.6 % (n = 8); moderate, 10.5 % (asymptomatic, 11; symptomatic, 0); and severe, 8.6 % (asymptomatic, 5; symptomatic, 4). Overall, 14.3 % (n = 4) patients with restenosis were symptomatic and 7.1 % (n = 2) underwent retreatment. Post-stenting residual stenosis greater than either 30 % (p = 0.016) or 50 % (p = 0.05) were significant for long-term restenosis. Plaques longer than 20 mm were significantly related to restenosis (p < 0.001).

Conclusion

The most important factor to explain restenosis was the immediate post-CAS residual stenosis and length of the plaque.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ et al (1998) Guidelines for carotid endarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, Am Heart Association. Stroke 29:554–562

    Article  PubMed  CAS  Google Scholar 

  2. Gupta A, Bhatia A, Ahuja A, Shalev Y, Bajwa T (2000) Carotid stenting in patients older than 65 years with inoperable carotid artery disease: a single-center experience. Catheter Cardiovasc Interv 50:1–8

    Article  PubMed  CAS  Google Scholar 

  3. Paniagua D, Howell M, Strickman N, Velasco J, Dougherty K, Skolkin M et al (2001) Outcomes following extracranial carotid artery stenting in high-risk patients. J Invasive Cardiol 13:375–381

    PubMed  CAS  Google Scholar 

  4. Hobson RW, Lal BK, Chakhtoura E, Goldstein J, Haser PB, Kubicka R et al (2003) Carotid artery stenting: analysis of data for 105 patients at high risk. J Vasc Surg 37:1234–1239

    Article  PubMed  Google Scholar 

  5. Maleux G, Bernaerts P, Thijs V, Vaninbroukx J, Daenens K, Fourneau I et al (2003) Extracranial carotid artery stenting in surgically high-risk patients using the Carotid Wallstent endoprosthesis: midterm clinical and ultrasound follow-up results. Cardiovasc Intervent Radiol 26:340–346

    Article  PubMed  Google Scholar 

  6. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W et al (2010) CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    Article  PubMed  CAS  Google Scholar 

  7. Frericks H, Kievit J, van Baalen JM, van Bockel JH (1998) Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature. Stroke 29:244–250

    Article  PubMed  CAS  Google Scholar 

  8. Moore WS, Kempczinski RF, Nelson JJ, Toole JF (1998) Recurrent carotid stenosis: results of the Asymptomatic Carotid Atherosclerosis Study. Stroke 29:2018–2025

    Article  PubMed  CAS  Google Scholar 

  9. Christiaans MH, Ernst JM, Suttorp MJ, van den Berg JC, Overtoom TT, Kelder JC et al (2003) Restenosis after carotid angioplasty and stenting: a follow-up study with duplex ultrasonography. Eur J Vasc Endovasc Surg 26:141–144

    Article  PubMed  CAS  Google Scholar 

  10. Khan MA, Liu MW, Chio FL, Roubin GS, Iyer SS, Vitek JJ (2003) Predictors of restenosis after successful carotid artery stenting. Am J Cardiol 92:895–897

    Article  PubMed  Google Scholar 

  11. Berkefeld J, Turowski B, Dietz A, Lanfermann H, Sitzer M, Schmitz-Rixen T et al (2002) Recanalization results after carotid stent placement. AJNR Am J Neuroradiol 23:113–120

    PubMed  Google Scholar 

  12. Chakhtoura EY, Hobson RW, Goldstein J, Simonian GT, Lal BK, Haser B et al (2001) In-stent restenosis after carotid angioplasty-stenting: incidence and management. J Vasc Surg 33:220–225

    Article  PubMed  CAS  Google Scholar 

  13. Setacci C, Pula G, Baldi I, de Donato G, Setacci F, Cappelli A et al (2003) Determinants of in-stent restenosis after carotid angioplasty: a case–control study. J Endovasc Ther 10:1031–1038

    Article  PubMed  Google Scholar 

  14. Willfort-Ehringer A, Ahmadi R, Gschwandtner ME, Haumer M, Lang W, Minar E (2002) Single-center experience with carotid stent restenosis. J Endovasc Ther 9:299–307

    Article  PubMed  Google Scholar 

  15. Gröschel K, Riecker A, Schulz JB, Ernemann U, Kastrup A (2005) Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke 36:367–373

    Article  PubMed  Google Scholar 

  16. Skelly CL, Gallagher K, Fairman RM, Carpenter JP, Velazquez OC, Parmer SS et al (2006) Risk factors for restenosis after carotid artery angioplasty and stenting. J Vasc Surg 44:1010–1015

    Article  PubMed  Google Scholar 

  17. Younis GA, Gupta K, Mortazavi A, Strickman NE, Krajcer Z, Perin E et al (2007) Predictors of carotid stent restenosis. Catheter Cardiovasc Interv 69:673–682

    Article  PubMed  Google Scholar 

  18. Van Laanen J, Hendriks JM, Van Sambeek MR (2008) Factors influencing restenosis after carotid artery stenting. J Cardiovasc Surg (Torino) 49:743–747

    Google Scholar 

  19. Shin SH, Stout CL, Richardson AI, DeMasi RJ, Shah RM, Panneton JM (2009) Carotid angioplasty and stenting in anatomically high-risk patients: safe and durable except for radiation-induced stenosis. J Vasc Surg 50:762–767, discussion 767–8

    Article  PubMed  Google Scholar 

  20. Eskandari MK, Usman AA, Garcia-Toca M, Matsumura JS, Kibbe MR, Morasch MD et al (2010) Eight-year institutional review of carotid artery stenting. J Vasc Surg 51:1145–1151

    Article  PubMed  Google Scholar 

  21. Lal BK, Hobson RW, Tofighi B, Kapadia I, Cuadra S et al (2008) Duplex ultrasound velocity criteria for the stented carotid artery. J Vasc Surg 47:63–73

    Article  PubMed  Google Scholar 

  22. Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, Goldstein LB, Meschia JF, Ferguson RD, Moore WS, Howard G, Brott TG (2011) CREST Investigators. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 42(3):675–680

    Article  PubMed  Google Scholar 

  23. Willfort-Ehringer A, Ahmadi R, Gschwandtner ME, Haumer A, Heinz G, Lang W et al (2003) Healing of carotid stents: a prospective duplex ultrasound study. J Endovasc Ther 10:636–642

    Article  PubMed  Google Scholar 

  24. Toma N, Matsushima S, Murao K, Kawaguchi K, Imanaka-Yoshida K, Yoshida T et al (2003) Histopathological findings in a human carotid artery after stent implantation. Case report. J Neurosurg 98:199–204

    Article  PubMed  Google Scholar 

  25. Lattimer CR, Burnand KG (1997) Recurrent carotid stenosis after carotid endarterectomy. Br J Surg 84:1206–1219

    Article  PubMed  CAS  Google Scholar 

  26. van den Bouwhuijsen QJ, Vernooij MW, Hofman A, Krestin GP, van der Lugt A, Witteman JC (2012) Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study. Eur Heart J 33:221–229

    Article  PubMed  Google Scholar 

  27. Tartari S, Rizzati R, Righi R, Deledda A, Capello K, Soverini R et al (2011) High-resolution MRI of carotid plaque with a neurovascular coil and contrast-enhanced MR angiography: one-stop shopping for the comprehensive assessment of carotid atherosclerosis. AJR Am J Roentgenol 196:1164–1171

    Article  PubMed  Google Scholar 

  28. Pierce DS, Rosero EB, Modrall JG, Adams-Huet B, Valentine RJ, Clagett GP et al (2009) Open-cell versus closed-cell stent design differences in blood flow velocities after carotid stenting. J Vasc Surg 49:602–606, discussion 606

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, QE II Hospital, Halifax, Canada

    Jai Jai Shiva Shankar

  2. Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China, 300052

    Jingwen Zhang

  3. Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, Canada

    Jingwen Zhang, Marlise dos Santos, Ravi Mohan & Cheemun Lum

  4. Department of Neurosurgery, The Ottawa Hospital, Ottawa, Canada

    Howard Lesiuk

Authors
  1. Jai Jai Shiva Shankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingwen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marlise dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Howard Lesiuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi Mohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cheemun Lum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marlise dos Santos.

Additional information

Jai Jai Shiva Shankar and Jingwen Zhang are joint first authors.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shankar, J.J.S., Zhang, J., dos Santos, M. et al. Factors affecting long-term restenosis after carotid stenting for carotid atherosclerotic disease. Neuroradiology 54, 1347–1353 (2012). https://doi.org/10.1007/s00234-012-1031-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-012-1031-y

Keywords

Search

Navigation