The Comparative Studies For Evaluation Of The In-stent Restenosis After Carotid Artery Stenting By CTA And CDU

Objective Through the follow-up and analysis for the patients who had acceptedCarotid Artery Stenting(CAS) after more than2years, determining whether the CarotidDuplex ultrasonograhy(CDU) can make a effective diagnosis for the In-Stent Restenosis(ISR).And attempt to find the apposite evaluation item for diagnosis and to identify riskfactors associated with ISR.Methods the patients for2years after CAS are followed via Three DimensionalComputed Tomography Angiography (CTA), ISR was defined as the stenosis rate [accordingto the North American Symptomatic Carotid Endarterectomy Trial(NASCET) method] asmeasured. The22vessels were each classified into one of two groups according to the degreeof stenosis defined on final CTA: the ISR-negative group and the ISR-positive group. The twogroups were compared in terms of patient factors, stent factors, laboratory data, medications.And we compared the relationship between CTA and CDU with in-stent max intima-mediathickness and stenosis rate, to study the relationship between results of CTA and CDU.Results The laterality of22stented arteries was left/right=14/8.The study populationconsisted of20patients(age: mean±SD=72.5±9.5years,female/male=2/18) with bilateralcarotid artery stents placed in two patients. ISR-positive Group(N=2) and ISR-negativeGroup(N=20) were defined according to the result of CTA. Gender female, hypertension,diabetes, Hyperlipidemia, low HDL and high LDL, inflammation, stent deformity, andantiplatelet medications were no significant differences between the ISR-positive group andthe ISR-negative group. The duration between CAS and CTA was significantly longer in the ISR-positive group than in the ISR-negative group. There was a good correlation betweenCTA and CDU in regards to in-stent max IMT, stenosis rate and stenosis area. By contrast, thecorrelation between stenosis rate and Peak systolic velocity(PSV) was not good, however, thecorrelation between PSV and the stenosis rate of in-stent most stenotic portion（MSP） wasbetter than the correlation between PSV and stenosis rate.Conclusions A past history of cancer might be a risk factor for ISR. CTA and CDU havea good evaluation of the role of ISR.CDU results and CTA results had very goodconsistency. The in-stent max IMT and PSV of CDU could predict late-onset ISR, butrequired a combination with other hospital checkups. CDU can be used to diagnosis ISR asinitial checkup, by combining with the CTA, it was an acceptable up method for follow-up ofCAS patients beyond the2-year follow-up time point.