Neointimal proliferation within carotid stents is more pronounced in diabetic patients with initial poor glycaemic state.
OBJECTIVE
We studied the influence of initial hyperglycaemia on neointimal proliferation within carotid Wallstents.


METHODS
A total of 112 patients were followed by duplex sonography after carotid stenting for 24 months. Patients were assigned to three groups: non-diabetic subjects (group A) and diabetic patients, who were assigned according to their baseline HbA(1)c values, to group B1(HbA(1)c<or=6.5%) or group B2 (HbA(1)c>6.5%).


RESULTS
At baseline the groups did not differ with respect to other vascular risk factors and residual stenosis on angiograms. The maximal thickness of the layer between the stent and the perfused lumen was measured at the duplex follow-ups. At 3 months the typical ultrasonic structure of the neointima was clearly discernible. From this point on, group B2 differed significantly ( p<0.001) compared with B1 and A with respect to the maximal thickness of neointima and the time course of its ingrowth: group A vs B1 vs B2 was 0.51+/-0.39 vs 0.52+/-0.33 vs 0.56+/-0.35 at 3 months, 0.91+/-0.27 vs 0.90+/-0.38 vs 1.14+/-0.48 at 6 months, 1.02+/-0.24 vs 0.97+/-0.34 vs 1.21+/-0.44 at 12 months and 1.09+/-0.23 vs 1.10+/-0.31 vs 1.23+/-0.37 at 24 months.


CONCLUSIONS
Initial hyperglycaemia seems to be a predictor of more pronounced neointimal proliferation after carotid stenting independent of diabetes. As intimal hyperplasia is known to be responsible for stent restenosis, strict optimisation of the hyperglycaemic state should be aimed at before elective carotid artery stenting.
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria. andrea.willfort.@akh-wien.ac.at.
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Willfort-Ehringer
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Ahmadi
Department of Endocrinology and Metabolism, General Hospital of Vienna, University of Vienna Medical School, Vienna, Austria.
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Gessl
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Gschwandtner
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Haumer
Department of Neurology, General Hospital of Vienna, University of Vienna Medical School, Vienna, Austria.
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Lang
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Minar
Department of Medical Statistics, General Hospital of Vienna, University of Vienna Medical School, Vienna, Austria.
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Zehetmayer
Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Ehringer
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D016893:Carotid Stenosis / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D017539:Tunica Intima / Q000473:pathology*
D001786:Blood Glucose; D006442:Glycated Hemoglobin