The Relationship of CHADS2 Score with In-stent Restenosis in Patients Undergoing Iliac Artery Stenting

Abstract

Objectives: Percutaneous intervention to aortoiliac occlusive disease (AIOD) is an approved choice of treatment instead of open surgery. However, despite improvement stent technology, in-stent restenosis (ISR) still remains a potential problem, especially in long-term follow-up of these patients. CHADS2 score is mainly a risk stratification tool for atrial fibrillation; however, it is found to be associated with the severity of atherosclerosis and worse outcome of percutaneous interventions. Thus, we aimed to interrogate the relationship between CHADS2 score and ISR in patients with stent implantation for AIOD. Methods: This was a retrospective, observational study that included 419 consecutive patients who had successful common iliac artery (CIA) and external iliac artery stent implantation. Post-procedural ISR is evaluated by either ultrasonography or angiography for each patient in the follow-up period. Patients were then divided into two groups ISR (+) and ISR (–). CHADS2 score was calculated for every patient. Results: ISR was detected in 47 out of 419 patients. Patients who had ISR had smaller stent diameter (8.4±0.9 vs. 7.2±2.8, p=0.005) and longer stent length (80 [59–120] mm vs. 59 [39–100] mm, p<0.001) than those without ISR. CHADS2 score was significantly found increased in patients with ISR than those without ISR (2.04 ± 0.98 vs. 1.45±0.93, p<0.001). Chronic obstructive pulmonary disease (COPD) (hazard ratios [HR]: 2.85, 95% confidence interval [CI]: 1.535–5.293, p=0.001), CHADS2 score (HR: 1.571, 95% CI: 1.186–2.081, p=0.002), and decreased stent diameter (HR: 0.582, 95% CI: 0.366–0.926, p=0.022) were found to be independently associated with ISR. Conclusion: Our study demonstrated that COPD, CHADS2 score, and stent diameter were associated with ISR for patients who had successful iliac artery stent implantation. According to our study, this simple and applicable scoring system can be used to predict patients at high risk for ISR.