Balloon angioplasty and stent implantation induce a vascular inflammatory reaction.
OBJECTIVE
To investigate whether peripheral balloon angioplasty with and without stent implantation independently causes an inflammatory vascular response measured by serum acute-phase reactants.


METHODS
This was a prospective cohort study enrolled 388 consecutive patients (218 men; median age 70 years, interquartile range 59-76) with peripheral artery disease undergoing balloon angioplasty (n = 187), stent implantation (n = 140), and diagnostic angiography (control group, n = 61). C-reactive protein (CRP) measured by standard and high-sensitivity assays, serum amyloid A (SAA), fibrinogen, and white blood cell (WBC) count were obtained at baseline and at 8, 24, and 48 hours postintervention. Polynomial logistic regression analysis was used to assess the independent association of acute-phase reactants and the interventional group.


RESULTS
CRP levels measured by both standard and the high-sensitivity assays significantly increased after balloon angioplasty (standard CRP, p = 0.02; high-sensitivity CRP, p = 0.02) and stent implantation (standard CRP, p = 0.004; high-sensitivity CRP, p = 0.008) compared to the control group adjusting for age, sex, duration of fluoroscopy, volume of contrast, and periprocedural complications. SAA values differed only between the stent group and controls (p = 0.05). Fibrinogen and WBCs were not different among the 3 interventional groups.


CONCLUSIONS
Balloon injury and stent implantation induce a vascular inflammatory response at the dilated vessel segment measurable by serum acute-phase parameters. The standard CRP assay is adequate to quantify acute-phase response in these patients.
Schillinger
Martin
M
Department of Angiology, University of Vienna Medical School, Austria. martin.schillinger@akh-wien.ac.at
Exner
Markus
M
Mlekusch
Wolfgang
W
Haumer
Markus
M
Ahmadi
Ramazanali
R
Rumpold
Helmut
H
Wagner
Oswald
O
Minar
Erich
E
D000368:Aged; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis*; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D000685:Serum Amyloid A Protein / Q000032:analysis*; D012720:Severity of Illness Index; D015607:Stents; D014657:Vasculitis / Q000097:blood / Q000209:etiology*
D018836:Inflammation Mediators; D000685:Serum Amyloid A Protein; D005340:Fibrinogen; D002097:C-Reactive Protein