Patterns of in-stent restenosis after carotid artery stenting: Classification and implications for long-term outcome

Lal, Brajesh K.; Kaperonis, Elias; Cuadra, Salvador A.; Kapadia, Indravadan; Hobson, Robert W.

doi:10.1016/j.jvs.2007.07.022

Cited by 76 publications

(49 citation statements)

References 25 publications

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“…2,3,8,9 The pattern of carotid ISR may predict the long-term prognosis of patients after CA stenting. 13 Therefore, reliable methods of determining ISR are critical.…”

Section: Yan Et Al Carotid Dus Vs Ivus In Detecting Isr 441mentioning

confidence: 99%

Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis

Yan

Clark²,

Jaff³

et al. 2009

Circ: Cardiovascular Interventions

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Background-Duplex ultrasonography criteria for assessing the severity of carotid artery (CA) in-stent restenosis are not well established. Methods and Results-We analyzed 39 patients (40 CAs) who underwent CA stenting with baseline and 6-month follow-up carotid duplex ultrasonography and intravascular ultrasound. Intravascular ultrasound measurements included minimum luminal diameter, percent diameter, and lumen area stenosis. Duplex ultrasonography measurements included peak systolic velocity (PSV), percentage change in PSV, end-diastolic velocity (EDV), and internal-to-common CA PSV ratio (ICA/CCA). Receiver operating characteristic curves assessed each duplex measurement to detect Ն50% diameter, Ն75% lumen area stenosis, and minimum luminal diameter Ͻ3 mm at follow-up. At 6-month intravascular ultrasound follow-up, Ն50% diameter and Ն75% lumen area CA in-stent restenosis occurred in 20% and 25%, respectively; minimum luminal diameter Ͻ3 cm occurred in 48%. Area under receiver operating characteristic curves for PSV, EDV, and ICA/CCA were 0.85, 0.96, and 0.89 for Ն50% diameter stenosis and 0.89, 0.93, and 0.88 for Ն75% lumen area stenosis, respectively. Optimal PSV, EDV, and ICA/CCA criteria to detect Ն50% diameter and Ն75% lumen area CA in-stent restenosis were greater compared with those for native CA. A Ͼ98% increase in PSV had the highest specificity, whereas the combination of EDV Ͼ41 cm/s and ICA/CCA Ͼ2 had the highest sensitivity in detecting Ն75% lumen area CA in-stent restenosis. Conclusions-PSV, EDV, and ICA/CCA PSV ratio were good discriminators for detecting significant diameter and lumen area greater compared with those for native CA.

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“…2,3,8,9 The pattern of carotid ISR may predict the long-term prognosis of patients after CA stenting. 13 Therefore, reliable methods of determining ISR are critical.…”

Section: Yan Et Al Carotid Dus Vs Ivus In Detecting Isr 441mentioning

confidence: 99%

Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis

Yan

Clark²,

Jaff³

et al. 2009

Circ: Cardiovascular Interventions

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“…17 In this context, patients with CAS may benefit from routine screening for heart failure, which has been found in up to 10% of patients and subsequent treatment. 4 In our cohort, particularly patients with inadequate glycemic control had a poor survival after CAS. Thus screening for inadequate glycemic control by HbA 1c and a more stringent glycemic control may be another very effective measure in CAS patients to improve long-term mortality.…”

Section: Discussionmentioning

confidence: 63%

“…So far, single risk factors such as medical high risk, diffuse proliferative hyperplasia after CAS, diabetes mellitus, low high-density lipoprotein cholesterol levels, low body mass index, and contralateral carotid occlusion have been described but no comprehensive risk assessment has been performed. [3][4][5][6][7] The identification of a comprehensive risk profile determining mortality in this high-risk population with advanced age and high probability of generalized atherosclerotic disease is of particular clinical interest, specifically if reversible risk factors are included in the risk profile and late outcome may be improved by their treatment. A comprehensive risk management may be of particular relevance for patients with asymptomatic carotid stenosis in whom competing risks are more likely to impact late outcome.…”

mentioning

confidence: 99%

A Validated Risk Score to Predict Outcomes after Carotid Stenting

Hoke

Ljubuncic²,

Steinwender³

et al. 2012

Circ: Cardiovascular Interventions

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Background-Periprocedural outcome has been extensively investigated in patients undergoing carotid artery stenting.However, risk factors contributing to long-term mortality have not been comprehensively assessed. We aimed to establish a validated clinical risk score for long-term mortality in patients after carotid artery stenting. Methods and Results-Two independent cohorts after successful carotid artery stenting (602 and 552 patients) were prospectively investigated. Multivariable Cox regression and bootstrap variable selection were used to select the bestfitting multivariable model. The mortality rate was 35% in the derivation and 39% in the validation cohort during a median follow-up of 6.5 and 7.4 years, respectively. The following variables were identified as most robust risk factors in the derivation cohort: age, heart failure, diabetes mellitus, relative lymphocyte count, prothrombin time, peripheral artery disease, and contralateral carotid occlusion. A weighted multimarker risk score yielded an area under the receiver operating characteristic curve of 0.79 in the derivation (P<0.001) and of 0.69 (P<0.001) in the validation cohort. In comparison, the best area under the receiver operating characteristic curves for single risk factors were 0.67 and 0.63, respectively. For optimal clinical use, a simplified risk score was also developed, which discriminated very well from very low to very high risk. The risk of all-cause mortality ranged from 8% for a score of 1 to 93% for a score of 7 (P<0.001) in the derivation and from 11% to 100% in the validation cohort (P<0.001). Conclusions-

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“…A possible site of stenting and hence of ISR is the carotid. As reported in [23], a more that 40% diameter reduction of the vessel can be considered critical for the safety of the patient, while a reduction of more than 80% must be regarded extremely dangerous and requires a further surgical treatment. The most severe forms if IRS occur when the lesions are wide ( mm long) and extend beyond the margins of the stents.…”

Section: The Stentmentioning

confidence: 99%

Design of Implanted RFID Tags for Passive Sensing of Human Body: The STENTag

Occhiuzzi

Contri

Marrocco

2012

IEEE Trans. Antennas Propagat.

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Abstract-Numerical processing of passive UHF-RFID tags' response may provide physical insight about the hosting object or about the nearby environment. This idea is here extended to implanted antennas with the purpose to sense the evolution of some human physiological and pathological process involving a local change of effective permittivity inside the body. The goal is to understand how master the design of this class of devices taking into account both communication and sensing capabilities. An ad hoc design methodology is here presented and discussed by means of a realistic medical case concerning the modification of an endo-vascular device to achieve a STENTag able to sense the state of the vessel wherein it has been implanted.Index Terms-Biosensor, implantable biomedical device, passive sensing, RFID.

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Patterns of in-stent restenosis after carotid artery stenting: Classification and implications for long-term outcome

Cited by 76 publications

References 25 publications

Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis

Carotid Duplex Ultrasound Velocity Measurements Versus Intravascular Ultrasound in Detecting Carotid In-Stent Restenosis

A Validated Risk Score to Predict Outcomes after Carotid Stenting

Design of Implanted RFID Tags for Passive Sensing of Human Body: The STENTag

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