Nowadays, the number of patients undergoing carotid artery stenting (CAS) is increasing rapidly, and these patients require follow-up to monitor the patency of the device and the potential development of an in-stent restenosis (ISR).
Patients undergoing CAS at our institution underwent duplex ultrasound (DUS) at 6 months, 12 months, and yearly thereafter, using a prespecified protocol. Restenosis was defined as a more than 50% diameter-reducing stenosis. Patients with DUS-diagnosed restenosis underwent carotid computerized tomography angiography (CTA) to confirm the presence of ISR. The frequency of restenosis was calculated by Kaplan–Meier survival estimates and was compared during a 2-year follow-up period. Interactions between restenosis and baseline variables were assessed using odds ratio.
Between August 2007 and March 2012 were performed 100 procedures in 96 patients, with a median age of 72.9 years. The mean duration of follow-up was 29.2 months (±8.4). Restenosis occurred in 6 carotid arteries. The Kaplan–Meier estimate for the frequency of restenosis in 2 years was 6.0% and for severe restenosis was 3.0%. There were no occlusions. Diabetic patients seem to have a higher risk of ISR (OR = 3.23, 95% CI .55-18.9). Carotid CTA was in agreement with the degree of stenosis estimated by DUS in all cases.
Our results, using a DUS protocol and a specific peak systolic velocity threshold, showed that the frequency of restenosis at 2 years after CAS is 6.0% and so that CAS is probably a durable revascularization procedure. We emphasize the diagnostic agreement achieved between DUS and carotid CTA.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Stroke and Cerebrovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Heart disease and stroke statistics—2012 update: a report from the American Heart Association.Circulation. 2012; 125: e2-220
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis.N Engl J Med. 1991; 325: 445-453
- Randomised Trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).Lancet. 1998; 351: 1379-1387
- Wall mechanics of the stented extracranial caotid artery.Stroke. 2003; 34: 222-224
- Arterial remodeling and hemodynamics in carotid stents: a prospective duplex ultrasound study over 2 years.J Vasc Surg. 2004; 39: 728-734
- Healing of carotid stents: a prospective duplex ultrasound study.J Endovasc Ther. 2003; 10: 636-642
- A numerical assessment of wall shear stress changes after endovascular stenting.J Biomech. 2005; 38: 2019-2027
- Relationship between oversizing of self-expanding stents and late loss index in carotid stenting.Cathet Cardiovasc Diagn. 1998; 45: 139-143
- Restenosis after coronary stenting in current clinical practice.Am Heart J. 1998; 135: 510-518
- Stenting of Symptomatic Atherosclerosis Lesions in the Vertebral or Intracranial Arteries (SSYLVIA): study results.Stroke. 2004; 35: 92
- In-stent recurrent stenosis after carotid artery stenting: life table analysis and clinical relevance.J Vasc Surg. 2003; 38: 68
- Long-term risk of carotid restenosis in patients randomly assigned to endovascular treatment or endarterectomy in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomized trial.Lancet Neurol. 2009; 8: 908-917
- Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenosis at 2 years: a multinational, prospective, randomized trial.Lancet Neurol. 2008; 7: 893-902
- Restenosis is more frequent after carotid stenting than after endarterectomy.Stroke. 2011; 42: 1015-1020
- Stenting and angioplasty with protection in patients at high risk for endarterectomy: the SAPPHIRE study.Circulation. 2002; 106: 2986-2989
- Carotid artery stenting: analysis of data for 105 patients at high risk.J Vasc Surg. 2003; 37: 1234-1239
- Carotid duplex velocity criteria revisited for the diagnosis of carotid in-stent restenosis.Vascular. 2007; 15: 119-125
- Follow-up of stented carotid arteries by Doppler ultrasound.Neurosurgery. 2002; 51: 639-643
- Carotid artery stenting: is there a need to revise ultrasound velocity criteria?.J Vasc Surg. 2004; 39: 58-66
- Comparative study of operative treatment and PTA/stenting for recurrent carotid disease.J Vasc Surg. 2001; 34: 831-838
- Duplex ultrasound velocity criteria for the stented carotid artery.J Vasc Surg. 2008; 47: 63-73
- Combined carotid stenting and urgent coronary artery surgery in unstable angina patients with severe carotid stenosis.Interact Cardiovasc Thorac Surg. 2009; 9: 278-281
- Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial.Lancet Neurol. 2012; 11: 755-763
- Restenosis after coronary placement of various stent types.Am J Cardio. 2001; 87: 34-39
- CREST (carotid revascularization endarterectomy versus stent trial): background, design and current status.Semin Vasc Surg. 2000; 13: 139-143
- Protected carotid-artery stenting versus endarterectomy in high-risk patients.N Engl J Med. 2004; 351: 1493-1501
- CT angiography of stented carotid arteries: comparison with Doppler ultrasonography.J Endovas Ter. 2007; 14: 489-497
- Optimal carotid duplex velocity criteria for defining the severity of carotid in-stent restenosis.J Vasc Surg. 2008; 48: 589-594
- The diagnostic accuracy of computed tomography angiography for traumatic or atherosclerotic lesions of the carotid and vertebral arteries: a systematic review.Eur J Radiol. 2003; 48: 88-102
- Grading carotid intrastent restenosis.Stroke. 2008; 39: 1189-1196
- Duplex ultrasound criteria for the identification of carotid stenosis should be laboratory specific.Stroke. 1997; 28: 597-602
- Determining in-stent stenosis of carotid arteries by duplex ultrasound criteria.J Endovasc Ther. 2005; 12: 346-353
- Computed tomography angiography validates duplex sonographic evaluation of carotid artery stenosis.Am Surg. 2003; 69: 842-847
- Management of carotid restenosis.J Cardiovasc Surg (Torino). 2006; 47: 153-160
- Long-term follow-up and clinical outcome of carotid restenosis.J Vasc Surg. 1989; 10: 662-668
- The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation.J Am Coll CArdiol. 1998; 32: 584-589
- Effect of contralateral severe stenosis or carotid occlusion on duplex criteria of ipsilateral stenoses: comparative study of various duplex parameters.J Vasc Surg. 1995; 22: 751-761
- Volume flow rate evaluation in patients with obstructive arteriosclerotic disease.Cerebrovas Dis. 2004; 18: 312-317
Published online: February 21, 2014
Accepted: December 1, 2013
Received in revised form: November 4, 2013
Received: July 28, 2013
The authors declare to have no conflict of interests.
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.