Acute-phase response after stent implantation in the carotid artery: association with 6-month in-stent restenosis.
OBJECTIVE
To determine the prognostic importance of periintervention serum levels of acute-phase reactants in 6-month restenosis after stent implantation in the carotid artery.


METHODS
One hundred eight consecutive patients with 70% or greater stenosis of the internal carotid artery (ICA) according to the North American Symptomatic Carotid Endarterectomy Trial criteria underwent successful stent implantation in the ICA in a prospective cohort study. Six-month patency was evaluated at color-coded duplex ultrasonography. The association between in-stent restenosis (> or =50%, North American Symptomatic Carotid Endarterectomy Trial criterion) and C-reactive protein (CRP) and serum amyloid A levels at baseline and at 24 and 48 hours after intervention was assessed.


RESULTS
Restenosis was found in 15 (14%) patients within 6 months. CRP level at 48 hours, exemplary for the postintervention acute-phase response, was significantly (P =.01) associated with 6-month restenosis by using multiple logistic regression analysis. Recurrent stenosis after prior stent implantation in the carotid artery (odds ratio, 9.2; 95% CI: 1.6, 53.2; P =.01) and residual stenosis of 10%-30% after stent implantation (odds ratio, 9.7; 95% CI: 1.6, 59.3; P =.01) were independent clinical predictors of restenosis.


CONCLUSIONS
Extent of vascular inflammatory response after stent implantation in the carotid artery measured with acute-phase reactants is associated with 6-month patency. Recurrent stenosis after prior stent implantation and initial suboptimal technical result seem to be clinically relevant predictors of postangioplasty outcome.
Schillinger
Martin
M
Department of Angiology, University of Vienna, Medical Faculty, Währinger Gürtel 18-20/6J, Austria. martin.schillinger@akh-wien.ac.at
Exner
Markus
M
Mlekusch
Wolfgang
W
Rumpold
Helmut
H
Ahmadi
Ramazanali
R
Sabeti
Schila
S
Lang
Wilfried
W
Wagner
Oswald
O
Minar
Erich
E
D000209:Acute-Phase Proteins / Q000032:analysis*; D000210:Acute-Phase Reaction / Q000097:blood*; D000368:Aged; D016893:Carotid Stenosis / Q000097:blood* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
D000209:Acute-Phase Proteins