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Acute-Phase Response after Stent Implantation in the Carotid Artery: Association with 6-month In-Stent Restenosis¹

¹ From the Departments of Angiology (M.S., R.A., S.S., E.M.), Laboratory Medicine (M.E., W.M., H.R., O.W.), and Clinical Neurology (W.L.), University of Vienna, Medical Faculty, Währinger Gürtel 18-20/6J, A-1090 Vienna, Austria. Received March 1, 2002; revision requested April 25; final revision received August 29; accepted September 24. Address correspondence to M.S. (e-mail: martin.schillinger@akh-wien.ac.at).

PURPOSE: To determine the prognostic importance of periintervention serum levels of acute-phase reactants in 6-month restenosis after stent implantation in the carotid artery.

MATERIALS AND METHODS: One hundred eight consecutive patients with 70% or greater stenosis of the internal carotid artery (ICA) according to the North American Symptomatic Carotid Endarterectomy Trial criteria underwent successful stent implantation in the ICA in a prospective cohort study. Six-month patency was evaluated at color-coded duplex ultrasonography. The association between in-stent restenosis (50%, North American Symptomatic Carotid Endarterectomy Trial criterion) and C-reactive protein (CRP) and serum amyloid A levels at baseline and at 24 and 48 hours after intervention was assessed.

RESULTS: Restenosis was found in 15 (14%) patients within 6 months. CRP level at 48 hours, exemplary for the postintervention acute-phase response, was significantly (P = .01) associated with 6-month restenosis by using multiple logistic regression analysis. Recurrent stenosis after prior stent implantation in the carotid artery (odds ratio, 9.2; 95% CI: 1.6, 53.2; P = .01) and residual stenosis of 10%–30% after stent implantation (odds ratio, 9.7; 95% CI: 1.6, 59.3; P = .01) were independent clinical predictors of restenosis.

CONCLUSION: Extent of vascular inflammatory response after stent implantation in the carotid artery measured with acute-phase reactants is associated with 6-month patency. Recurrent stenosis after prior stent implantation and initial suboptimal technical result seem to be clinically relevant predictors of postangioplasty outcome.

© RSNA, 2003

Index terms: Arteries, restenosis, 172.72, 904.721 • Arteritis, 172.2581, 904.29, 904.458 • Carotid arteries, interventional procedures, 172.1269, 904.1268 • Carotid arteries, stenosis or obstruction, 172.72, 904.721

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