Risk Factors for the Development of Carotid Artery In-Stent Restenosis: Multivariable Analysis

OBJECTIVES

In this study, we evaluated the relationship between certain patient and stent characteristics with regards to their association with the development of restenosis.

BACKGROUND

Carotid artery stenosis is a major cause of stroke. Carotid artery stenting is an FDA approved method for the treatment of carotid artery stenosis. However, carotid artery stenting has been fraught with lumen loss and in-stent restenosis. The literature is limited in regard to variables affecting long term patency after carotid artery stenting.

METHODS

This is a retrospective chart review study investigating the variables affecting the long term patency in patients who underwent carotid artery stenting. The data was analyzed using a Multivariable logistic regression models.

RESULTS

148 patients were included in the study. 123 patients did not develop signs of restenosis after 1 year, while 25 patients developed restenosis defined on annual follow up carotid duplex ultrasound. The odds ratio of developing restenosis for current/former smokers vs. never smokers was 10.1 (p = 0.018), closed vs. open cell design stents was 12.5 (p = 0.008). The odds ratio of developing restenosis decreases by 50.1% for every 1 mm increase in the diameter (p = 0.021). Data was collected and reanalyzed at 3 years to look for any changes in risk factors that become significant which showed that the chance of developing restenosis increases by 11.2% for every 1 mm increase in the length of the stent.

CONCLUSIONS

Our data suggest that the risk of developing restenosis is elevated in those with a history of previous/current tobacco use; those treated with closed-cell as opposed to open-cell design. We also found that restenosis is positively associated with stent length and inversely associated with stent diameter. The aforementioned factors should be considered in the management of carotid artery stenosis.

Prevalence of emerging cardiovascular risk factors in younger individuals with a family history of premature coronary heart disease and low Framingham risk score

INTRODUCTION

The purpose of this study was to assess the prevalence of emerging cardiac risk factors in individuals with a family history of premature coronary heart disease (CHD) and who were predicted to be low-risk for cardiovascular (CV) disease based on their Framingham risk score.

METHODS

We prospectively evaluated 89 younger men and women with a family history of premature CHD and who had a low Framingham risk score. Patients with CHD or CHD equivalents were excluded. All patients were screened for emerging clinical and lipid risk factors.

RESULTS

Coronary calcium was present in 38% of patients and C-reactive protein > 3 mg/dl was present in 24% of patients. Low levels of high-density lipoprotein (HDL2) cholesterol were the most prevalent emerging lipid risk factor and was present in 72% of the study group. More individuals had low levels of HDL2 than total HDL (34% versus 71%; p-value =0.001). Triglyceride- (TG)-rich remnant lipoproteins were present in 49% of patients.

CONCLUSIONS

The Framingham risk score poorly predicts CV risk in younger healthy persons with a family history of premature CHD. The prevalence of subclinical CHD and emerging clinical and lipid risk factors is high in these patients. The most prevalent lipid risk factor was low levels of HDL2. Individuals with a family history of premature CHD may benefit from screening for emerging risk factors to better assess their CV risk.

Endovascular treatment of a left carotid artery "bowtie" pseudoaneurysm with a covered Wallgraft stent

The authors present an unusual case of a young male patient with a large left common carotid artery pseudoaneurysm in a shape similar to that of a bowtie treated with a covered Wallgraft. The Wallgraft is a covered stent originally designed to be used in the treatment of tracheobronchial fistula and peripheral arterial applications. The favorable outcome of this case illustrates its endovascular application in nonsurgical traumatic injuries of the carotid artery.