Postprocedural high‐density lipoprotein cholesterol predicts carotid stent patency at 1 year

Abstract

The durability of carotid artery stenting (CAS) is affected by the occurrence of myointimal proliferation and in-stent restenosis (ISR). We aimed to identify clinical, angiographic, and laboratory predictors of ISR, paying special attention to postprocedural metabolic factors. A total of 102 consecutive patients with successful CAS for > or =70% atherosclerotic internal carotid artery stenosis were followed up with neurological assessment and duplex sonography 1 day, 1 month, and 1 year after CAS. Lipid profile and hemoglobin A(1c) were tested at the 1-month follow-up visit. Ten (10%) patients had ISR > or =50% after 1 year. Compared with patients without ISR (n = 92), patients with ISR were more often current smokers (33% vs. 70%, P = 0.034) and had significantly lower 1-month high-density lipoprotein (HDL) cholesterol: median (range) 47 (24-95) mg/dl vs. 39.5 (25-50) mg/dl, P = 0.031. Multivariate logistic regression analyses identified 1-month HDL cholesterol >45 mg/dl as the only independent predictor of carotid stent patency at 1 year (P = 0.033, OR = 0.09, 95% CI 0.01-0.83). Postprocedural HDL cholesterol levels predict carotid stent patency at 1 year. With the possibility of elevation of HDL cholesterol by lifestyle changes and medication, this finding may have implications for the future management of patients undergoing CAS.

High‐density lipoproteins suppress chemokine expression and proliferation in human vascular smooth muscle cells

“…It also suggests that rHDLs may protect against the development of neointimal hyperplasia and thereby prolong stent patency. This is consistent with clinical studies that find patients with higher HDL cholesterol levels (Ͼ45 mg/dl) have improved stent patency at 1 yr (27) and reduced major cardiac events following stent implantation (28). Vascular SMC chemokine expression is regulated via the transcription factor NF-B (7,8) and further upstream by the PI3K/Akt pathway (6,8).…”

Periprocedural Cilostazol Treatment and Restenosis after Carotid Artery Stenting: The Retrospective Study of In-Stent Restenosis after Carotid Artery Stenting (ReSISteR-CAS)

“…Given the 6.4% incidence of ISR or TVR in patients who did not receive cilostazol periprocedurally, similar to that reported previously, the lower incidence of ISR in the cilostazol-treated patients might have affected our results. Factors reportedly associated with ISR after CAS include advanced age, female sex, placement of more than one stent, postprocedural residual stenosis, 9 restenosis after CEA, stenosis after radiotherapy, 23 hyperglycemia, 24 elevated postprocedural inflammation markers, 25 lower high-density lipoprotein cholesterol level, 26 and others. We found an association between stent diameter and the occurrence of ISR.…”

High-density lipoprotein cholesterol as a predictor of clinical outcomes in patients achieving low-density lipoprotein cholesterol targets with statins after percutaneous coronary intervention

“…In patients who received PCI, the HDL-C level before PCI was an independent predictor of in-stent restenosis and first-year mortality 13–15. After carotid artery stenting, post-procedural HDL-C levels predicted stent patency at first year 16. A meta-analysis of statin trials showed that statin treatment has a beneficial impact on TVR 17.…”