title: Elevated levels of pre-procedural high-sensitivity C-reactive protein is associated with midterm restenosis after extra- and intracranial stenting.
abstract: OBJECTIVE
  High-sensitivity C-reactive protein (hsCRP) is an inflammatory marker associated with subsequent coronary events and neointimal hyperplasia after coronary artery stent placement. We sought to determine if elevated levels of hsCRP are associated with restenosis after placement of extra- and intracranial stents.
  
  
  METHODS
  We retrospectively reviewed 73 consecutive patients at Michigan State University from July 2006 until June 2007 who underwent treatment with carotid artery stent placement or intracranial stent placement. Data were collected in regards to demographics, pre-procedural hsCRP, and LDL levels, and angiographic variables characterizing the lesion before and after treatment. A binary logistic regression model was constructed to determine independent predictors of restenosis.
  
  
  RESULTS
  A total of 73 patients with a mean age of 69 +/- 11 years were studied. A total of 57 patients were treated with extracranial carotid stenting, 22 (38%) of whom were symptomatic, while 16 patients underwent intracranial stenting (all were symptomatic). There were 9 patients (4 intracranial stents [25%] and 5 carotid stents [8.8%]) who developed a restenosis of >50%. In binary logistic regression modeling, the following variables were found to be independently predictive of developing restenosis: smaller vessel diameter (OR .49, 95% CI .23-.98, P-value .046) and elevated hsCRP (OR 2.2, 95% CI 1.29-6.66, P-value .018).
  
  
  CONCLUSIONS
  Elevated levels of pre-procedural hsCRP may be predictive of the development of neointimal hyperplasia in patients treated with extra- or intracranial stenting procedures. Future prospective multicenter studies will be required to confirm these findings.
authors.affiliation: Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University/Sparrow Health System, East Lansing, MI, USA. guptar@ccf.org
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Archit
authors.initials: A
authors.lastname: Bhatt
authors.forename: Mounzer
authors.initials: M
authors.lastname: Kassab
authors.forename: Arshad
authors.initials: A
authors.lastname: Majid
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D016893:Carotid Stenosis / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008824:Michigan; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D002097:C-Reactive Protein