Preprocedural Carotid Plaque Echolucency as a Predictor of In-Stent Intimal Restenosis after Carotid Artery Stenting

Takao, Naoki; Hagiwara, Yuta; Shimizu, Takahiro; Soga, Kaima; Tsuchihashi, Yoko; Otsubo, Haruki; Tatsuno, Kentaro; Takaishi, Satoshi; Usuki, Noriko; Yoshie, Tomohide; Takada, Tatsuro; Ueda, Toshihiro; Hasegawa, Yasuhiro; Yamano, Yoshihisa

doi:10.1016/j.jstrokecerebrovasdis.2020.105339

Cited by 12 publications

(6 citation statements)

References 40 publications

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“…The most fundamental problem in ISR is intimal hyperplasia. 18 However, moderate to mild restenosis is lower in open-cell stents than in closed-cell stents in previous studies. 19 Nevertheless, there was no difference between the open-cell stent and the closed-cell stent in severe ISR.…”

Section: Discussionmentioning

confidence: 79%

The Effects of Short/Long-Term Administration of Dual Antiplatelet Therapy on Restenosis in Patients With Carotid Artery Stenting

Karluka

Onan

Akgül

et al. 2022

MNJ

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Background: There is no consensus on the duration of dual antiaggregant therapy after carotid stenting. This study aimed to evaluate the early contribution of dual antiaggregant therapy for three or six months to stent restenosis. Objective: This study aimed to identify the correlation between stent restenosis and the duration of dual antiplatelet therapy (DAPT) in carotid artery stenting (CAS) subjects by retrospectively scanning a CAS procedure dataset. Methods: Patients who underwent a CAS procedure received dual DAPT (acetylsalicylic acid (ASA) + clopidogrel) were recruited for this study. The first group was the patients who received dual antiaggregants for three months, and the second group was the patients who received dual antiaggregants for six months. Patients' demographic characteristics, comorbidities, and radiological results were reviewed. Follow-up activities for the following six months were assessed for stent status, complications, and new ischemic lesions. Results: A total of 65 patients received ASA (acetylsalicylic acid) + clopidogrel for six months, while the remaining 118 patients were treated for three months. The restenosis rates were not significantly different between the two groups. The complication and adverse event frequencies were also similar. Conclusion: This study revealed that the efficacy of 3-month and 6-month DAPT is similar regarding the restenosis frequency, and there are no significant differences in complication frequency.

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Section: Discussionmentioning

confidence: 79%

The Effects of Short/Long-Term Administration of Dual Antiplatelet Therapy on Restenosis in Patients With Carotid Artery Stenting

Karluka

Onan

Akgül

et al. 2022

MNJ

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“…We observed a higher rate of re-stenosis in covered stent grafts (75% vs. 25%), but not on a significant level ( p = 0.24). The increased re-stenosis rate is possibly attributable to the occlusion morphology, since we used covered stent grafts mainly for soft plaques with thrombotic coating, and these lesions were associated with an increased re-stenosis rate in some studies [ 28 , 29 ]. However, due to the size of the case series, we cannot draw any general conclusions about the comparison between covered and uncovered stents, and covered stents have shown improved long-term patency as compared to bare metal stents at different vascular beds in larger RCTs [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Open Retrograde Stenting of Proximal Innominate and Common Carotid Artery Stenosis

Kapalla,

Busch,

Wolk

et al. 2024

JPM

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Purpose: The evidence regarding the treatment of open retrograde stenting of innominate artery (IA) or common carotid artery stenosis (CCA) is limited, and is suspected to carry a high risk of stroke and death. Therefore, the objective of this study was to evaluate the outcomes of such hybrid procedures. Methods: A retrospective, monocentric study of all patients who underwent retrograde stenting of proximal IA and CCA stenosis via surgical cutdown of the CCA, with or without concomitant CEA, between 2016 and 2023 was performed. Results: Overall, 33 patients were treated. A total of 15 patients (45.5%) were male, with the mean age being 67 ± 9.1 years, and 58% (n = 19) of the patients presented with neurological symptoms. Open retrograde stenting was performed in 67% (n = 22) in ACC, and in 33% (n = 11) in IA stenosis. A total of 20 patients (61%) underwent retrograde stenting with synchronous ipsilateral CEA for concomitant stenosis of the carotid bifurcation. There was no 30-day mortality. The perioperative stroke rate was 3% (n = 1) with complete symptom recovery. During the follow up at 32 months (95% CI: 24–39), three late deaths (9.1%) and one symptomatic stent occlusion were observed and, in five patients (15.2%), re-intervention for restenosis was necessary. Conclusions: Open retrograde stenting for of proximal IA or CCA stenosis with or without CEA, in case of tandem carotid lesions, can be performed safely with a low rate of early adverse events. Continuous follow up examinations are necessary due to relevant instent re-stenosis rates.

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“…After follow-ups for six months to 2 years, the incidence of in-stent restenosis (ISR) has been found to range from 3.3% to 21% [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Plaque Characteristics by Contrast-Enhanced Ultrasound and Stent Restenosis following Carotid Artery Stenting: A Retrospective Study

Gimžauskaitė,

Inčiūra,

Diringytė

et al. 2024

Medicina

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Background and objective: carotid artery stenosis contributes significantly to ischemic strokes, with management options including carotid endarterectomy (CEA) and carotid artery stenting (CAS) ischemic stroke risk can be reduced. Controversies persist regarding their efficacy and factors influencing complications, and understanding the relationship between atherosclerotic plaque characteristics and stent restenosis after CAS is crucial. Methods: we conducted a retrospective study involving 221 patients who underwent CAS for symptomatic or asymptomatic carotid artery stenosis. Comprehensive assessments of plaque morphology were performed using contrast-enhanced ultrasound (CEUS) before CAS. Patient demographics, including smoking status and diabetes, were also recorded. Stent restenosis was diagnosed using various imaging modalities, including ultrasound, angiography, and digital subtraction angiography (DSA). Results: plaque analysis using CEUS revealed a significant association between plaque grade and restenosis incidence (p < 0.001), particularly with grade 0 (11.1%) and grade 2 plaques (66.7%). Smoking was notably associated with plaque vascularization and restenosis (p < 0.001), while diabetes did not significantly impact plaque characteristics or restenosis risk (p > 0.05). The mean duration of restenosis was 17.67 months. Stenting was the most frequent treatment modality for restenosis (70.6%). However, no significant relationship was found between restenosis type and plaque morphology (p = 0.268). Furthermore, while no clear relationship was observed between plaque morphology and the type of restenosis, our findings underscored the importance of plaque characterization in predicting post-CAS outcomes. Conclusions: this study highlights the utility of CEUS in predicting stent restenosis following CAS. There was a significant association between stent restenosis within 12–24 months after the carotid stenting procedure and an elevated grade of plaque vascularization. Moreover, one of the main factors possibly determining the grade of plaque vascularization was smoking. Further research is warranted to elucidate the underlying mechanisms and refine risk stratification in this patient population.

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Preprocedural Carotid Plaque Echolucency as a Predictor of In-Stent Intimal Restenosis after Carotid Artery Stenting

Cited by 12 publications

References 40 publications

The Effects of Short/Long-Term Administration of Dual Antiplatelet Therapy on Restenosis in Patients With Carotid Artery Stenting

The Effects of Short/Long-Term Administration of Dual Antiplatelet Therapy on Restenosis in Patients With Carotid Artery Stenting

Open Retrograde Stenting of Proximal Innominate and Common Carotid Artery Stenosis

Assessment of Plaque Characteristics by Contrast-Enhanced Ultrasound and Stent Restenosis following Carotid Artery Stenting: A Retrospective Study

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