title: The association between CYP2C19 genotype and of in-stent restenosis among patients with vertebral artery stent treatment.
abstract: OBJECTIVE
  Preventing stroke through endovascular treatment with vertebral artery stent remains a great challenge due to the occurrence of an in-stent restenosis.
  
  
  METHODS
  In this study, a retrospective analysis was conducted in 90 patients who had been treated with VAS between 2004 and 2011 in Nanjing Drum Tower Hospital. Patients were followed up at 3 months, 6 months,and 1 year after VAS treatment and annually thereafter. For each time point, neurological function tests, vessel ultrasound and computer tomography angiography were performed to preliminarily screen the vessel stenosis. Digital subtraction angiography was used to verify the narrow sign on CTA or ultrasound. Clinical features of each patient including clopidogrel metabolization genes (CYP2C19, CYP3A4, and P2Y12) were recorded with purpose to investigate the possible risk factors for the development of ISR.
  
  
  RESULTS
  Single factor analysis dem-onstrated that hyperlipidemia (P < 0.05) and CYP2C19 (P < 0.01) loss-of-function geno-type increased the likelihood of ISR. A multiple logistic cox regression analysis also showed that stroke patients with hyperlipidemia (HR 3.719, 95% CI: 1.094-12.637, P = 0.035), and CYP2C19 loss-of-function genotype (HR 2.959, 95% CI: 1.325-6.610, P = 0.008) were more likely to suffer from ISR. Furthermore, CYP2C19 alleles were mainly divided into three groups: wt/wt (CYP2C19 *1/*1), wt/m (CYP2C19 *1/*2 and *1/*3), and m/m (CYP2C19 *2/*2,*2/*3 and*3/*3). Recurrent rate of ischemic stroke in m/m and wt/m groups was higher than the wt/wt group (OR: 0.141, 95% CI: 0.016-1.221, P = 0.042).
  
  
  CONCLUSIONS
  The study leads to the conclusion that hyperlipidemia and CYP2C19 impotency are possible risk factors for the development of ISR in VAS-treated patients with ischemic. Moreover, VAS-treated patients with CYP2C19 impotency were susceptible to recurrent stroke during our 54-month follow-up.
authors: Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China; Stroke Center for Diagnosis and Therapy in Jiangsu province, Nanjing, China.
authors: Yong-Juan
authors: YJ
authors: Lin
authors: Jing-Wei
authors: JW
authors: Li
authors: Mei-Juan
authors: MJ
authors: Zhang
authors: Lai
authors: L
authors: Qian
authors: Wen-Jie
authors: WJ
authors: Yang
authors: Chun-Lei
authors: CL
authors: Zhang
authors: Yuan
authors: Y
authors: Shao
authors: Yang
authors: Y
authors: Zhang
authors: Yu-Jie
authors: YJ
authors: Huang
authors: Yun
authors: Y
authors: Xu
mesh_terms: D000368:Aged; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D065731:Cytochrome P-450 CYP2C19; D057510:Endovascular Procedures; D005260:Female; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000235:genetics* / Q000401:mortality / Q000601:surgery*; D014711:Vertebral Artery / Q000601:surgery*
chemical_list: D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19
keywords: In-stent restenosis; Risk factors; Stroke; Vertebral artery