Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
Clin Res Cardiol. 2017 Jul;106(7):493-500. doi: 10.1007/s00392-017-1078-1. Epub 2017 Feb 8.
Whereas in-stent restenosis (ISR) is widely discussed after coronary stenting procedures, this phenomenon is a considerable problem after interventional treatment of carotid artery stenosis as well. We sought to quantify ISR rate and to identify important respective risk factors in our cohort.
We retrospectively analyzed data of our carotid artery stenting database comprising 1165 angiographically successful interventional procedures during the last 19 years. Significant ISR was assessed by Doppler ultrasound and defined as a flow velocity exceeding 300 cm/s representing a lumen narrowing >70%. Examinations were performed the day after intervention, at follow-up visits 1, 6 and 12 months after index hospitalization and once a year afterwards.
Thirty-nine patients (3.4%) developed a significant ISR > 70% during the follow-up period (median 19.6 months, IQR 5.1-49.6 months). In 13 of them, restenosis was caused by a mechanical collapse (stent crush) of the implanted stent. All patients with significant ISR were free of neurological events during follow-up and 31 patients underwent a stent-in-stent implantation. We found a shorter stent length, a narrower stent diameter, performance of post-dilatation as well as stent type to significantly influence development of ISR.
ISR > 70% after carotid artery stenting is a rare finding also during long-term follow-up. Especially in patients treated with balloon-expandable stents, post-dilatation reduced ISR significantly. As ISR was rare and clinically benign, this technique seems to remain a good therapy option in patients with significant carotid artery stenosis.
虽然冠状动脉支架置入术后广泛讨论了支架内再狭窄（ISR），但这种现象也是颈动脉狭窄介入治疗后一个相当严重的问题。我们试图在我们的队列中量化 ISR 发生率并确定重要的相关危险因素。
我们回顾性分析了我们的颈动脉支架数据库中的数据，该数据库包含了过去 19 年中 1165 例经血管造影成功的介入治疗。多普勒超声评估有意义的 ISR，并定义为血流速度超过 300cm/s，代表管腔狭窄>70%。检查在介入治疗后第 1 天、索引住院后 1、6 和 12 个月的随访访问以及此后每年进行。
在随访期间，39 名患者（3.4%）出现了明显的 ISR >70%（中位数 19.6 个月，IQR 5.1-49.6 个月）。其中 13 例由植入支架的机械塌陷（支架挤压）引起。所有有明显 ISR 的患者在随访期间均无神经事件，31 例患者进行了支架内支架植入。我们发现支架长度较短、支架直径较窄、后扩张以及支架类型与 ISR 的发展显著相关。
颈动脉支架置入术后 ISR >70%也是一种罕见的发现，即使在长期随访中也是如此。特别是在使用球囊扩张支架治疗的患者中，后扩张显著降低了 ISR。由于 ISR 罕见且临床良性，因此该技术似乎仍然是严重颈动脉狭窄患者的一种良好治疗选择。
