Risk factors for restenosis after carotid artery angioplasty and stenting

Christopher L. Skelly, Katherine Gallagher, Ronald M. Fairman, Jeffrey P. Carpenter, Omaida C Velazquez, Shane S. Parmer, Edward Y. Woo

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objectives: With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS. Methods: Consecutive patients undergoing CAS between January 2002 and October 2004 at a tertiary care hospital were retrospectively reviewed. Patient, filter, and stent selection were left to the discretion of the attending surgeon. High-risk patients were defined by significant comorbidities or a hostile neck (prior surgery or radiation, or both), and risk factor analysis was performed. In-stent restenosis was defined as >60%, and selective angiography was performed on patients with an in-stent restenosis >80% by duplex ultrasound imaging. Results: Reviewed were 101 patients (55 men, 46 women) who underwent 109 CAS procedures. Comorbidities were typical for patients with atherosclerosis. In addition, 38% (n = 41) of procedures were performed in patients who had prior neck surgery, of which 29% (n = 32) had previous ipsilateral carotid endarterectomy. Seventeen patients (16%) had a history of neck cancer, and all had prior neck radiation. Median follow-up was 5 months (range, 0 to 30 months). Neurologic complications included three transient ischemic attacks (2.8%) and one nondisabling stroke (0.9%). There were two myocardial infarctions (1.9%) and no periprocedural deaths (30 days), for a combined stroke, myocardial infarction, and death rate of 2.9%. Asymptomatic in-stent restenosis developed in 12 carotids (11%), five of which required endovascular intervention, with a mean of 6 months to restenosis. Univariate Cox proportional hazard regression models were used to determine risk factors for the development of restenosis. Prior stroke, transient ischemic attack, amaurosis fugax, and prior neck cancer were all significant risk factors. When these significant risk factors from univariate analysis were put into multivariate analysis, however, the only marginally significant risk factor was prior neck cancer (P = .06). Kaplan-Meier analysis revealed a cumulative freedom from in-stent restenosis at 24 months of 88% ± 6% in patients without neck cancer compared with 27% ± 17% (P = .02) in patients with neck cancer. Conclusions: CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.

Original languageEnglish
Pages (from-to)1010-1015
Number of pages6
JournalJournal of Vascular Surgery
Volume44
Issue number5
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

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Angioplasty
Carotid Arteries
Stents
Head and Neck Neoplasms
Neck
Stroke
Transient Ischemic Attack
Statistical Factor Analysis
Comorbidity
Amaurosis Fugax
Myocardial Infarction
Radiation
Carotid Endarterectomy
Kaplan-Meier Estimate
Tertiary Healthcare
Proportional Hazards Models
Tertiary Care Centers
Nervous System
Ultrasonography
Atherosclerosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Skelly, C. L., Gallagher, K., Fairman, R. M., Carpenter, J. P., Velazquez, O. C., Parmer, S. S., & Woo, E. Y. (2006). Risk factors for restenosis after carotid artery angioplasty and stenting. Journal of Vascular Surgery, 44(5), 1010-1015. https://doi.org/10.1016/j.jvs.2006.07.039

Risk factors for restenosis after carotid artery angioplasty and stenting. / Skelly, Christopher L.; Gallagher, Katherine; Fairman, Ronald M.; Carpenter, Jeffrey P.; Velazquez, Omaida C; Parmer, Shane S.; Woo, Edward Y.

In: Journal of Vascular Surgery, Vol. 44, No. 5, 01.11.2006, p. 1010-1015.

Research output: Contribution to journalArticle

Skelly, CL, Gallagher, K, Fairman, RM, Carpenter, JP, Velazquez, OC, Parmer, SS & Woo, EY 2006, 'Risk factors for restenosis after carotid artery angioplasty and stenting', Journal of Vascular Surgery, vol. 44, no. 5, pp. 1010-1015. https://doi.org/10.1016/j.jvs.2006.07.039
Skelly, Christopher L. ; Gallagher, Katherine ; Fairman, Ronald M. ; Carpenter, Jeffrey P. ; Velazquez, Omaida C ; Parmer, Shane S. ; Woo, Edward Y. / Risk factors for restenosis after carotid artery angioplasty and stenting. In: Journal of Vascular Surgery. 2006 ; Vol. 44, No. 5. pp. 1010-1015.
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abstract = "Objectives: With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS. Methods: Consecutive patients undergoing CAS between January 2002 and October 2004 at a tertiary care hospital were retrospectively reviewed. Patient, filter, and stent selection were left to the discretion of the attending surgeon. High-risk patients were defined by significant comorbidities or a hostile neck (prior surgery or radiation, or both), and risk factor analysis was performed. In-stent restenosis was defined as >60{\%}, and selective angiography was performed on patients with an in-stent restenosis >80{\%} by duplex ultrasound imaging. Results: Reviewed were 101 patients (55 men, 46 women) who underwent 109 CAS procedures. Comorbidities were typical for patients with atherosclerosis. In addition, 38{\%} (n = 41) of procedures were performed in patients who had prior neck surgery, of which 29{\%} (n = 32) had previous ipsilateral carotid endarterectomy. Seventeen patients (16{\%}) had a history of neck cancer, and all had prior neck radiation. Median follow-up was 5 months (range, 0 to 30 months). Neurologic complications included three transient ischemic attacks (2.8{\%}) and one nondisabling stroke (0.9{\%}). There were two myocardial infarctions (1.9{\%}) and no periprocedural deaths (30 days), for a combined stroke, myocardial infarction, and death rate of 2.9{\%}. Asymptomatic in-stent restenosis developed in 12 carotids (11{\%}), five of which required endovascular intervention, with a mean of 6 months to restenosis. Univariate Cox proportional hazard regression models were used to determine risk factors for the development of restenosis. Prior stroke, transient ischemic attack, amaurosis fugax, and prior neck cancer were all significant risk factors. When these significant risk factors from univariate analysis were put into multivariate analysis, however, the only marginally significant risk factor was prior neck cancer (P = .06). Kaplan-Meier analysis revealed a cumulative freedom from in-stent restenosis at 24 months of 88{\%} ± 6{\%} in patients without neck cancer compared with 27{\%} ± 17{\%} (P = .02) in patients with neck cancer. Conclusions: CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.",
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AU - Parmer, Shane S.

AU - Woo, Edward Y.

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N2 - Objectives: With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS. Methods: Consecutive patients undergoing CAS between January 2002 and October 2004 at a tertiary care hospital were retrospectively reviewed. Patient, filter, and stent selection were left to the discretion of the attending surgeon. High-risk patients were defined by significant comorbidities or a hostile neck (prior surgery or radiation, or both), and risk factor analysis was performed. In-stent restenosis was defined as >60%, and selective angiography was performed on patients with an in-stent restenosis >80% by duplex ultrasound imaging. Results: Reviewed were 101 patients (55 men, 46 women) who underwent 109 CAS procedures. Comorbidities were typical for patients with atherosclerosis. In addition, 38% (n = 41) of procedures were performed in patients who had prior neck surgery, of which 29% (n = 32) had previous ipsilateral carotid endarterectomy. Seventeen patients (16%) had a history of neck cancer, and all had prior neck radiation. Median follow-up was 5 months (range, 0 to 30 months). Neurologic complications included three transient ischemic attacks (2.8%) and one nondisabling stroke (0.9%). There were two myocardial infarctions (1.9%) and no periprocedural deaths (30 days), for a combined stroke, myocardial infarction, and death rate of 2.9%. Asymptomatic in-stent restenosis developed in 12 carotids (11%), five of which required endovascular intervention, with a mean of 6 months to restenosis. Univariate Cox proportional hazard regression models were used to determine risk factors for the development of restenosis. Prior stroke, transient ischemic attack, amaurosis fugax, and prior neck cancer were all significant risk factors. When these significant risk factors from univariate analysis were put into multivariate analysis, however, the only marginally significant risk factor was prior neck cancer (P = .06). Kaplan-Meier analysis revealed a cumulative freedom from in-stent restenosis at 24 months of 88% ± 6% in patients without neck cancer compared with 27% ± 17% (P = .02) in patients with neck cancer. Conclusions: CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.

AB - Objectives: With carotid artery stenting (CAS) becoming an ever-increasing procedure, we sought to determine risk factors for in-stent restenosis after CAS. Methods: Consecutive patients undergoing CAS between January 2002 and October 2004 at a tertiary care hospital were retrospectively reviewed. Patient, filter, and stent selection were left to the discretion of the attending surgeon. High-risk patients were defined by significant comorbidities or a hostile neck (prior surgery or radiation, or both), and risk factor analysis was performed. In-stent restenosis was defined as >60%, and selective angiography was performed on patients with an in-stent restenosis >80% by duplex ultrasound imaging. Results: Reviewed were 101 patients (55 men, 46 women) who underwent 109 CAS procedures. Comorbidities were typical for patients with atherosclerosis. In addition, 38% (n = 41) of procedures were performed in patients who had prior neck surgery, of which 29% (n = 32) had previous ipsilateral carotid endarterectomy. Seventeen patients (16%) had a history of neck cancer, and all had prior neck radiation. Median follow-up was 5 months (range, 0 to 30 months). Neurologic complications included three transient ischemic attacks (2.8%) and one nondisabling stroke (0.9%). There were two myocardial infarctions (1.9%) and no periprocedural deaths (30 days), for a combined stroke, myocardial infarction, and death rate of 2.9%. Asymptomatic in-stent restenosis developed in 12 carotids (11%), five of which required endovascular intervention, with a mean of 6 months to restenosis. Univariate Cox proportional hazard regression models were used to determine risk factors for the development of restenosis. Prior stroke, transient ischemic attack, amaurosis fugax, and prior neck cancer were all significant risk factors. When these significant risk factors from univariate analysis were put into multivariate analysis, however, the only marginally significant risk factor was prior neck cancer (P = .06). Kaplan-Meier analysis revealed a cumulative freedom from in-stent restenosis at 24 months of 88% ± 6% in patients without neck cancer compared with 27% ± 17% (P = .02) in patients with neck cancer. Conclusions: CAS has been shown to be safe and effective in high-risk patients, with minimal adverse events.

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