Carotid in-stent restenosis may be more common than thought

Among patients who underwent carotid artery stenting, in-stent restenosis of at least 50% was higher than some previous estimates, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting.

However, in-stent restenosis of at least 80% and late neurologic events were uncommon, Grant Scott, MD, vascular surgery fellow at West Virginia University, said during a presentation.

Scott and colleagues retrospectively analyzed 450 patients (mean age, 68 years) who underwent CAS procedures and had their data collected prospectively.

“Most published studies have relatively short follow-up periods, which may lead to underestimating the incidence of carotid in-stent stenosis rates,” Scott and colleagues wrote in an abstract.

All patients had carotid duplex ultrasound immediately after the procedure and at 1, 6 and every 6 to 12 months thereafter. Outcomes of interest included freedom from in-stent restenosis of at least 50%, freedom from in-stent restenosis of at least 80%, freedom from reintervention, survival, stroke and transient ischemic attack. Mean follow-up was 40.3 months.

Among the cohort, 45% had symptomatic carotid artery stenosis, 65% had primary CAS and 35% had CAS due to post-carotid endarterectomy stenosis.

Late carotid in-stent restenosis of at least 50% was observed in 23% of patients, whereas late carotid in-stent restenosis of at least 80% was observed in 7.4% of patients, Scott said.

Late TIA occurred in 4.3% of patients and late stroke in 0.7%, whereas late reintervention was required in 5.2%, according to the researchers.

The rate of freedom from in-stent restenosis of at least 50% was 85% at 1 year, 79% at 2 years, 75% at 3 years, 72% at 4 years and 70% at 5 years, whereas the rate of freedom from in-stent restenosis of at least 80% was 96% at 1 year, 95% at 2 years, 93% at 3 years, 90% at 4 years and 89% at 5 years, Scott and colleagues found.

There was no difference between those who had primary CAS and those who had CAS due to post-carotid endarterectomy stenosis in freedom from in-stent restenosis of at least 50% (P = .54) or freedom from in-stent restenosis of at least 80% (P = .516).

Freedom from reintervention was 98% at 1 year, 96% at 2 years, 93% at 3 years, 93% at 4 years and 91% at 5 years, and did not differ between those who had primary CAS and those who had CAS due to post-carotid endarterectomy stenosis (P = .939), according to the researchers.

Late survival rates were 99% at 1 year, 97% at 2 years, 96% at 3 years, 94% at 4 years and 91% at 5 years, Scott and colleagues found.

“The incidence of 50% in-stent restenosis is relatively high; however, the rates of

80% restenosis and late neurologic events are low,” Scott and colleagues wrote in the abstract. – by Erik Swain

Reference:

Scott G, et al. S5: Scientific Session 5. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 20-23, 2018; Boston.

Disclosure: Cardiology Today’s Intervention could not confirm relevant financial disclosures at the time of publication.