The Relationship Between the Neutrophil-Lymphocyte Ratio and In-Stent Restenosis in Patients With Femoropopliteal Chronic Total Occlusions

Abstract

We investigated the relationship between the neutrophil-lymphocyte ratio (NLR) and in-stent restenosis (ISR) in patients with femoropopliteal chronic total occlusions (CTOs). The study enrolled 180 patients who had undergone successful stenting treatment for femoropopliteal CTO. Patients with ISR were subsequently classified into 2 groups: early-ISR (within 1 year) and late-ISR (after 1 year). The clinical characteristics, angiographic data, and follow-up data were recorded. The baseline NLR was significantly higher in the early-ISR group than that in the non-ISR group [3.96(2.14) and 3.33(2.73), p = .04]. Receiver operating characteristic curve analysis suggested an optimum early ISR NLR cutoff point of 3.62, which showed a sensitivity and specificity of 73.4% and 80.4%, respectively (area under the curve: 0.707, 95% confidence interval: 0.603-0.792, P < .001). A subgroup analysis was performed based on the NLR value (<3.62 vs ≥3.62). In the NLR ≥3.62 subgroup, the incidence of early ISR was higher than that of late ISR ( P < .01). In the multivariate analysis, NLR ≥3.62 was independently and positively associated with a higher risk of early ISR. In conclusion, NLR is independently associated with early ISR after stent implantation in patients with femoropopliteal CTO.

The relationship between neutrophil–lymphocyte ratio and in-stent restenosis in superficial femoral artery

“…The neutrophil-lymphocyte ratio (NLR) has been shown to be a marker of inflammation and closely related to increased cardiovascular mortality and morbidity [6,7]. Although the relationship between various inflammatory biomarkers, including NLR, and the occurrence of ISR has been investigated [8][9][10]. No studies have evaluated the effectiveness of the NLR value after (NLR after ), NLR change(NLR change ), defined as the NLR value before (NLR before ) and after (NLR after ) superficial femoral artery stenting (SFAS) intervention and NLR change ratio (NLR ratio ), defined as the ratio of NLR change to NLR before, in prediction of ISR in superficial femoral artery stents, which are at high risk for the occurrence of ISR.…”

A risk predictor of restenosis after superficial femoral artery stent implantation: relevance of mean platelet volume

“…This group reported activation of neutrophils and neutrophil-mediated oxidative burst in the inflammatory process of PCI-induced vessel injury and neointimal hyperplasia. Chang et al [26] recruited 180 patients and obtained venous blood samples one to three days before superficial femoral artery stent implantation. The neutrophil-lymphocyte ratio was computed using the absolute neutrophil count divided by the absolute lymphocyte count.…”

Response to the Letter to the Editor “The Relationship Between Neutrophil–Lymphocyte Ratio and In-Stent Restenosis”

“…7 As shown in our study, the relationship between NLR and CRP was analyzed, and a positive correlation was found. 13 Diabetes and hyperlipidemia are known risk factors for atherosclerosis and restenosis. 14,15 Our study also found a significantly higher incidence of early ISR in diabetic patients than nondiabetic patients.…”

“…14,15 Our study also found a significantly higher incidence of early ISR in diabetic patients than nondiabetic patients. 13 The proportion of diabetic patients in the high baseline NLR group (NLR ! 3.62) was significantly higher than that of the lower baseline NLR group (NLR < 3.62).…”

“…3.62) was significantly higher than that of the lower baseline NLR group (NLR < 3.62). 13 Diabetes and hyperlipidemia accelerate restenosis probably through aggravation of inflammatory response after stent implantation. 2,14 In an animal experiment, we found that hyperlipidemia, which induces an inflammatory state, accelerated carotid intimal hyperplasia in Apoe À/À mice.…”