In-stent Restenosis after Carotid Artery Stent Placement Comparing Maximum Plaque Predilation and Postdilation.

Abstract

Objective: To compare the incidence of in-stent restenosis (ISR) and ipsilateral neurological symptoms in patients treated with maximum plaque dilation before stent deployment (max-pre-D) and stent placement followed by angioplasty (post-D) technical variants of carotid artery stenting (CAS) at mid-term follow-up.

Methods: Single-center, real-world, retrospective comparative study of 307 patients treated in a single Vascular Surgery Unit between 2014 and 2018. The follow-up protocol consisted of duplex ultrasound performed at 1-, 6-, 12-months and annually thereafter. The primary outcome was to compare the incidence of ISR ≥ 70% in patients treated with post-D and max-pre-D. Secondary outcomes included between-group comparison of: i) symptomatic ISR, ii) reinterventions and iii) ipsilateral neurological events.

Results: 270 patients (121 max-pre-D, 149 post-D) fulfilling the inclusion criteria were included in the statistical analysis. Mean follow-up was 30.5 months (SD 25.6). The ISR rate was 4.1% (n=5) in max-pre-D group and 2.7% (n=4) in post-D group, with no significant difference in the survival analysis (log-rank p=0.664). Symptomatic ISR and retreatment occurred in three patients (33.3% of the total ISR for each outcome). Twenty-one ipsilateral neurological events occurred, 7 in the max-pre-D group (5.8%) and 14 in the post-D group (9.9%), with no statistically significant difference in survival analysis (log-rank p=0.315).

Conclusion: ISR and major neurological events did not differ significantly between the max-pre-D and post-D groups. Max-pre-D seems to be as effective as post-D technique in mid-term follow-up.