Association Between Carotid Plaque Properties Assessment By CTA And Carotid In-stent Restenosis

Objective Carotid artery atherosclerotic stenosis is one of the important causes of ischemic stroke.The degree of carotid artery stenosis in patients with carotid artery stenosis is closely related to the risk of stroke.Carotid artery stenting can play a role in mechanical repair of lumen and reconstruction of blood supply.Stent restenosis is one of the major complications affecting the long-term prognosis after carotid artery stenting.In this study,CTA was used to evaluate the relationship between the nature of carotid artery plaque and carotid artery restenosis.The purpose of this study was to evaluate the properties of carotid artery plaques using CTA before surgery(the plaques were divided into stable plaques and unstable plaques according to the main components of plaques),and to explore the correlation between different types of plaques and the occurrence of postoperative stent restenosis.It is expected to screen high-risk patients with stent restenosis timely and effectively before surgery,facilitate timely postoperative intervention,reduce the incidence of stent restenosis,and improve the long-term prognosis of patients with carotid artery stenting.Methods(1)from June 2013 to June 2018,patients with carotid atherosclerotic stenosis who successfully underwent carotid artery stenting in the department of neurology of the third clinical medical college of the three gorges university were studied.(2)patients who met the inclusion criteria received head and neck vascular CTA or DSA examination within6-12 months after surgery,and those patients with postoperative stent restenosis were set as the observation group,while those without postoperative restenosis were set as the control group.(3)gender,age,follow-up time,the nature of the preoperative stenosis plaque,preoperative blood triglyceride level,blood total cholesterol level,blood homocysteine level,the length,diameter and side of the stent,and whether the patients suffered from hypertension and diabetes were collected.(4)relevant data were analyzed to find the risk factors related to carotid artery stent restenosis.Results(1)a total of 104 cases met the inclusion criteria and were included in the study.There were 95 males and 9 females.There were 57 patients with hypertension and 21 patients with diabetes.There were 54 cases of left stent implantation and 50 cases of right stent implantation.There were 19 cases of restenosis and 85 cases without restenosis.The age of the restenosis group was(73.11±5.18)years old,and that of the non-restenosis group was(70.25±5.58)years old.The follow-up time was(242.52±53.32)days in therestenosis group and(243.96±56.81)days in the non-restenosis group.In the restenosis group,the preoperative stenosis was unstable plaques in 10 patients,and in the non-restenosis group,the preoperative stenosis was unstable plaques in 22 patients.The preoperative homocysteine level of the restenosis group was(16.39±7.77)μmol/L,and that of the non-restenosis group was(12.75±5.68)μmol/L.Preoperative blood triglyceride level(1.37 ± 0.59)mmol/L in the restenosis group and(1.69 ± 1.50)mmol/L in the non-restenosis group.Stent diameter was(8.78 ± 0.71)mm in the restenosis group and(8.74±1.09)mm in the non-restenosis group.The stent length was(35.78±6.07)mm in the restenosis group and(37.53 ± 4.86)mm in the non-restenosis group.Nineteen stents were placed in the restenosis group,including 11 on the left and 8 on the right.85 stents were placed in the non-restenosis group,including 43 on the left and 42 on the right.Among the 19 patients in the restenosis group,8 had diabetes and 13 had hypertension.Among the 85 patients in the no restenosis group,13 had diabetes and 44 had hypertension.The total restenosis rate was 18.2%.(2)univariate analysis suggested that there was no statistically significant difference between the restenosis group and the non-restenosis group in gender,postoperative follow-up time,preoperative blood triglyceride level,preoperative blood total cholesterol level,stent diameter,stent length,stent placement side,and hypertension(P>0.05).Preoperative blood homocysteine level,age,type of preoperative stenosis plaque and diabetes were significantly different between the restenosis group and the no restenosis group(P<0.05).(3)binary Logistic regression analysis showed that preoperative blood homocysteine level and the age of the patient were not independent risk factors for restenosis after CAS(P>0.05).Unstable carotid artery plaque is an independent risk factor for stent restenosis after carotid artery stenting(P<0.05).Diabetes is an independent risk factor for stent restenosis after carotid artery stenting(P<0.05).Conclusion unstable carotid artery plaque is an independent risk factor for stent restenosis after carotid artery stenting(P<0.05).Compared with stable plaque,the risk of stent restenosis is increased(OR=3.68,95% CI:1.15-11.80).Diabetes is an independent risk factor for stent restenosis after carotid artery stenting(P<0.05),with an increased risk of stent restenosis compared with patients without diabetes(OR=3.89,95%CI:1.11-13.56).