Park Sangil, Kim Bum Joon, Choi Hye-Yeon, Chang Dae-Il, Woo Ho Geol, Heo Sung Hyuk
Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea.
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Front Neurol. 2024 Aug 8;15:1411045. doi: 10.3389/fneur.2024.1411045. eCollection 2024.
After carotid artery angioplasty with stenting (CAS), it is unclear which risk factors are related to long-term outcomes, including in-stent restenosis (ISR). This study aimed to assess the factors associated with restenosis after CAS with a median follow-up of 35.7 months.
Patients who underwent CAS from January 2013 to December 2018 were included if they had symptomatic or asymptomatic carotid artery stenosis. The carotid Doppler ultrasonography (CDU) was followed up after the procedure. We defined at least 50% restenosis using the criteria that the internal carotid artery (ICA) peak systolic velocity (PSV) was greater than 224 cm/s or the ICA to common carotid artery PSV ratio was higher than 3.4. The risk factors for ISR were also assessed.
Of the 189 patients, 122 had symptomatic carotid artery stenosis, and 67 had asymptomatic carotid artery stenosis. Patients were evaluated by CDU for a median of 35.7 months (interquartile range 19.5 to 70.0). Kaplan-Meier analysis showed that the longest time to ISR was 39 months, and ISR-free was better in the asymptomatic CAS group. In all groups, ISR was independently associated with current smoker [adjusted odds ratio (aOR), 3.425; 95% confidence interval (CI), 1.086 to 10.801] and elevated ICA PSV at baseline (aOR, 1.004; 95% CI, 1.001 to 1.007).
Independent risk factors for ISR in the CAS group included current smoking and elevated ICA PSV at baseline. In the symptomatic CAS group, alcohol was independently associated with the ISR. ISR did not occur after 39 months from the CAS procedure in our study patients. Future studies with extended follow-up are necessary to fully understand the long-term outcomes of CAS.
在颈动脉血管成形术加支架置入术（CAS）后，尚不清楚哪些危险因素与包括支架内再狭窄（ISR）在内的长期预后相关。本研究旨在评估CAS术后再狭窄的相关因素，中位随访时间为35.7个月。
纳入2013年1月至2018年12月期间接受CAS治疗且有症状或无症状颈动脉狭窄的患者。术后进行颈动脉多普勒超声检查（CDU）随访。我们采用颈内动脉（ICA）收缩期峰值流速（PSV）大于224 cm/s或ICA与颈总动脉PSV比值高于3.4的标准定义至少50%的再狭窄。还评估了ISR的危险因素。
189例患者中，122例有症状性颈动脉狭窄，67例有无症状性颈动脉狭窄。患者接受CDU评估的中位时间为35.7个月（四分位间距为19.5至70.0个月）。Kaplan-Meier分析显示，ISR最长发生时间为39个月，无症状CAS组无ISR的情况更好。在所有组中，ISR与当前吸烟者独立相关[调整后的优势比（aOR），3.425；95%置信区间（CI），1.086至10.801]以及基线时ICA PSV升高（aOR，1.004；95%CI，1.001至1.007）。
CAS组ISR的独立危险因素包括当前吸烟和基线时ICA PSV升高。在有症状的CAS组中，饮酒与ISR独立相关。在我们的研究患者中，CAS术后39个月后未发生ISR。需要进行更长随访时间的未来研究以充分了解CAS的长期预后。
