Risk Factors Affecting In-stent Restenosis After Carotid Artery Stenting And Clopidogrel Drug-related Gene (CYP2C19) Mutation

Objectives: To analyze the related risk factors affecting in-stent restenosis(ISR)after carotid artery stenting(CAS).To evaluate the gene mutation of CYP2C19 in patients with atherosclerotic carotid artery stenosis,and to explore the correlation between CYP2C19 gene mutation and ISR after CAS.Method: Clinical data of 58 patients with atherosclerotic carotid artery stenosis undergone CAS were analyzed retrospectively.According to the cerebral angiography during follow-up,ISR was determined.A >50% stenosis in the stent or within 5mm around the edge of the stent is defined as ISR.Drug-related gene detection of aspirin and clopidogrel were performed during the perioperative period or follow-up.Risk factors that might induce the ISR after CAS include age(< 70 y,?70y),gender,hypertension,diabetes,peripheral vascular disease,cardiovascular disease,hyperlipidemia,high homocysteine,smoking history,symptoms associated with the stenosis vascular,clopidogrel drug-related gene(CYP2C19)testing results(mutation and unmutation),aspirin drug-related gene testing results(mutation and unmutation)and the type of the stent(open cells,closed cells).Univariate and multivariate analysis were performed on these factors.Fisher's exact test was performed in univariate analysis and logistic regression was performed in multivariable analysis.To evaluate the consistency between the mutation in clopidogrel drug-related gene and the mutation in aspirin drug-related gene,Mc Nemar test was used.Results:For the 58 patients(50 male and 8 female)with atherosclerotic carotid artery stenosis,58 carotid arteries were treated with CAS.The average age of the patients was 69.0±8.4 years old(51~84 years old).The average follow-up duration after CAS was 10.38±6.96 months(6~27 months).By the cerebral angiography during follow-up,9 patients were found to have ISR,and the average time of ISR occurrence was 7.44±2.13 months(6~12 months).The ISR rate after CAS was 15.52%(9/58).The mutation rate of clopidogrel drug-related gene in patients with atherosclerotic carotid artery stenosis was 55.17%(32/58).In Fisher's exact test,the P value of the history of smoking and the gene mutation of CYP2C19 were 0.015 and 0.028,respectively,P < 0.05.In the multivariate analysis(Logistic regression),it showed that the OR value of the history of smoking and the gene mutation of CYP2C19 were 17.747(95%CI:1.953~161.256,P =0.011)and 13.076(95%CI:1.037~164.810,P =0.047),respectively.Univariate and multivariate analysis indicated that the history of smoking and the mutation of clopidogrel drug-related gene are the related risk factors for the in-stent restenosis after CAS.For the consistency between the mutation in clopidogrel drug-related gene and the mutation in aspirin drug-related gene,the Mcnemar test showed that the P value was 1.000;there is no consistency between the two factors.Conclusion: There was a high mutation rate of clopidogrel drug-related gene in patients with atherosclerotic carotid artery stenosis.The history of smoking and the mutation of clopidogrel drug-related gene are the related risk factors for in-stent restenosis after CAS.For the same patient,there was a poor consistency between the mutation in clopidogrel drug-related gene and the mutation in aspirin drug-related gene.