title: Determinants of in-stent restenosis after carotid angioplasty: a case-control study.
abstract: OBJECTIVE
  To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience.
  
  
  METHODS
  Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2-72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan.
  
  
  RESULTS
  Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0-27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks). In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p=0.001) in this cohort.
  
  
  CONCLUSIONS
  The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure.
authors.affiliation: Dipartimento di Chirurgia Cardiovascolare, Università degli Studi di Siena, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.forename: Giorgio
authors.initials: G
authors.lastname: Pula
authors.forename: Irene
authors.initials: I
authors.lastname: Baldi
authors.forename: Giammarco
authors.initials: G
authors.lastname: de Donato
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Pieraccini
authors.forename: Alberto
authors.initials: A
authors.lastname: Cremonesi
authors.forename: Fausto
authors.initials: F
authors.lastname: Castriota
authors.forename: Eugenio
authors.initials: E
authors.lastname: Neri
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D016001:Confidence Intervals; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome