Abstract | PURPOSE: To examine if excessive in- stent neointimal formation causing a subcritical stenosis may indicate enhanced vascular reactivity in response to injury, thus predicting late cardiovascular events. METHODS: One hundred consecutive patients (64 men; median age 71 years) with high-grade internal carotid artery stenoses (68 asymptomatic, 32 symptomatic) underwent carotid artery stenting (CAS). High-sensitivity C-reactive protein ( hs-CRP) was measured before CAS. Patients were monitored with duplex ultrasound for excessive in- stent neointimal formation (flow-compromising lumen diameter reduction >/=50%), critical restenosis (>/=70%), or the occurrence of late major adverse cardiovascular events ( MACE) defined as myocardial infarction (MI), stroke, and death occurring later than 30 days poststenting. RESULTS: Over a median 23-month follow-up, excessive neointimal formation was observed in 14 (14%) patients, restenosis in 2 (2%), and 30 late MACE in 25 [25%: 4 MIs, 2 ipsilateral strokes (in the patients with restenosis), 8 contralateral strokes, and 16 cardiovascular deaths]. Cumulative MACE-free survival rates at 6, 12, and 24 months were 92%, 84%, and 77%, respectively. Baseline hs-CRP levels were associated both with neointimal hyperplasia (p=0.024) and MACE (p=0.021). Patients with excessive neointimal formation exhibited a significantly increased adjusted risk for MACE (hazard ratio 3.56, p=0.010). CONCLUSIONS: Excessive in- stent neointimal formation after CAS indicates an increased risk for late MACE, potentially reflecting a state of exaggerated vascular reactivity in response to injury. Inflammation, which is associated both with neointimal hyperplasia and MACE, seems a common characteristic of different vascular pathologies.
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Authors | Martin Schillinger, Markus Exner, Schila Sabeti, Jasmin Amighi, Oswald Wagner, Ramazanali Ahmadi, Erich Minar |
Journal | Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
(J Endovasc Ther)
Vol. 11
Issue 3
Pg. 229-39
(Jun 2004)
ISSN: 1526-6028 [Print] United States |
PMID | 15174911
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Aged
- C-Reactive Protein
(metabolism)
- Carotid Stenosis
(diagnostic imaging, mortality, therapy)
- Cause of Death
- Cerebral Infarction
(mortality)
- Female
- Fibromuscular Dysplasia
(diagnostic imaging, mortality, pathology)
- Humans
- Male
- Middle Aged
- Myocardial Infarction
(mortality)
- Prosthesis Failure
- Recurrence
- Risk
- Stents
- Survival Analysis
- Tunica Intima
(diagnostic imaging, pathology)
- Ultrasonography, Doppler, Duplex
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