In-stent restenosis after interventional treatment of carotid artery stenoses: a long-term follow-up of a single center cohort.
BACKGROUND
Whereas in-stent restenosis (ISR) is widely discussed after coronary stenting procedures, this phenomenon is a considerable problem after interventional treatment of carotid artery stenosis as well. We sought to quantify ISR rate and to identify important respective risk factors in our cohort.


METHODS
We retrospectively analyzed data of our carotid artery stenting database comprising 1165 angiographically successful interventional procedures during the last 19 years. Significant ISR was assessed by Doppler ultrasound and defined as a flow velocity exceeding 300 cm/s representing a lumen narrowing >70%. Examinations were performed the day after intervention, at follow-up visits 1, 6 and 12 months after index hospitalization and once a year afterwards.


RESULTS
Thirty-nine patients (3.4%) developed a significant ISR > 70% during the follow-up period (median 19.6 months, IQR 5.1-49.6 months). In 13 of them, restenosis was caused by a mechanical collapse (stent crush) of the implanted stent. All patients with significant ISR were free of neurological events during follow-up and 31 patients underwent a stent-in-stent implantation. We found a shorter stent length, a narrower stent diameter, performance of post-dilatation as well as stent type to significantly influence development of ISR.


CONCLUSIONS
ISR > 70% after carotid artery stenting is a rare finding also during long-term follow-up. Especially in patients treated with balloon-expandable stents, post-dilatation reduced ISR significantly. As ISR was rare and clinically benign, this technique seems to remain a good therapy option in patients with significant carotid artery stenosis.
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria. juergen.kammler@kepleruniklinikum.at.
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Kammler
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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H
Blessberger
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Lambert
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Kellermair
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Grund
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Nahler
Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
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M
Lichtenauer
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Schwarz
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Reiter
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.|Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Steinwender
Faculty of Medicine, Department of Cardiology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4021, Linz, Austria.
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Kypta
D000368:Aged; D000792:Angiography; D001317:Austria / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018608:Ultrasonography, Doppler
Carotid artery stenosis; Carotid artery stenting; In-stent restenosis