Risk factor impact on blood flow velocities and clinical outcomes of stented cervical and intracranial stenoses: preliminary observations

• Published in: Clinical neurology and neurosurgery 2012-09, Vol.114 (7), p.922-929
• Main Authors: Moreira, Tiago, Michel, Patrik, Binaghi, Stefano, Hirt, Lorenz
• Format: Article
• Language: English
• Subjects: Aged; Amaurosis Fugax - etiology; Angioplasty; Biological and medical sciences; Blood; Carotid Stenosis - physiopathology; Carotid Stenosis - surgery; Cerebral Angiography; Cerebrovascular Circulation; Clinical Competence; Clinical outcomes; Duplex/Doppler; Female; Follow-Up Studies; Graft Occlusion, Vascular - epidemiology; Heart attacks; Humans; Intracranial Arterial Diseases - physiopathology; Intracranial Arterial Diseases - surgery; Intracranial Arteriosclerosis - physiopathology; Intracranial Arteriosclerosis - surgery; Intracranial Embolism - prevention & control; Ischemic Attack, Transient - etiology; Learning Curve; Male; Medical imaging; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Neurology; Neurosurgery; Platelet Aggregation Inhibitors - therapeutic use; Retrospective Studies; Risk Factors; Stent; Stents; Stroke; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ultrasonography; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures - education; Vascular Surgical Procedures - methods; Veins & arteries; Velocity criteria
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2012.02.005

Abstract Objectives The role of angioplasty/stenting procedures, neurointerventionist experience, vascular risk factors, medical treatment and blood flow velocities were analysed to identify possible causes of intra-stent restenosis (ISR) following stenting of cervical and/or intracranial arteries, assuming progressive atherosclerosis to be the shared mechanism in both territories. Patients. 26 cerebrovascular patients subjected to stenting of severe (≥85%) symptomatic or asymptomatic carotid stenoses or moderate-to-severe (≥50%) intracranial or vertebral stenoses were included. Methods Clinical, radiological and ultrasonographic follow-up data were analysed retrospectively. Results Overall, stenting of the internal carotid artery (ICA) induced significant reductions in peak systolic velocities at 2 years (96 ± 31 cm/s vs. 358.2 ± 24.9 cm/s at baseline). The procedure-related ischemic complications rate was 7.4% (one hemispheric stroke and one TIA). The rate of ISR ≤ 50% was 8% in the ICA at 2 years; was 50% in the common carotid artery (CCA) at 1 year, with concomitant distal ICA stenosis in 75% of CCA stenting, but all ISR were asymptomatic. Patients with ISR of the ICA were significantly younger (56.8 ± 4.5 vs. 71.3 ± 3.6 years, P = 0.042) and had significantly more risk factors (5.5 ± 0.9 vs. 3 ± 0.3, P = 0.012). No ISR ≥ 70% was detected. Conclusions ISR is relatively infrequent and, when present, it is mild and asymptomatic. Restenosis is more frequent in younger patients and those with several risk factors, and it may also be related to stenting of previous carotid endarterectomy.