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Mechanisms and Predictors of Carotid Artery Stent Restenosis

A Serial Intravascular Ultrasound Study

David J. Clark, MD^_*,, Sara Lessio, MD^_*,1, Margaret O’Donoghue, MD^_*, Con Tsalamandris, MD, Robert Schainfeld, DO^_* and Kenneth Rosenfield, MD, FACC^_*,_*

^_* Division of Cardiovascular Medicine and Research, St. Elizabeth’s Medical Center of Boston, Boston, Massachusetts
Departments of Cardiology and Medicine, Austin Hospital, Melbourne, Australia.

View larger version (86K): [in a new window]   Figure 1 Designated sites of quantitative carotid angiography (QCA) and intravascular ultrasound (IVUS) measurements. QCA: (A) before intervention; (B) post-carotid stent deployment; (C) six-month follow-up. (D) IVUS: (Top) calcified plaque at lesion site pre-intervention; (Bottom) internal carotid artery (ICA) stent post-procedure. 1 = distal ICA reference; 2 = lesion site; 3 = proximal common carotid artery (CCA) reference; 4 = lesion site in-stent; 5 = ICA stent minimal luminal diameter (MLD); 6 = ICA stent reference site; 7 = CCA stent MLD; 8 = CCA stent reference site; 9 = lumen MLD (line) and lumen area (circle); 10 = stent MLD (line) and stent area (circle).

View larger version (23K): [in a new window]   Figure 2 Quantitative intravascular ultrasound assessment (mean ± SD) of late stent enlargement ( stent), neointimal hyperplasia area (NIH), and late lumen loss ( lumen) at designated sites of the internal carotid artery (ICA) and common carotid artery (CCA) stent. (Top) Absolute changes (mm2). (Bottom) Percentage change (%). The p values refer to a comparison of changes amongst different segments of the stent. Solid bars = ICA lesion site; open bars = reference site ICA stent; gray bars = minimal lumen diameter CCA stent; ruled bars = reference site CCA stent. *p < 0.05; **p < 0.01; ***p < 0.001.

View larger version (24K): [in a new window]   Figure 3 Correlation between amount of neointimal hyperplasia (NIH, mm2) and late stent enlargement ( stent, mm2) at the internal carotid artery lesion site (r = 0.64; p < 0.001).

View larger version (19K): [in a new window]   Figure 4 (Left) Correlation between the immediate post-procedure distal internal carotid artery (ICA) reference vessel diameter (mm) measured by quantitative carotid angiography (QCA) and percentage restenotic area after six months. (Right) Correlation between the immediate post-procedure ICA stent minimal lumen diameter (MLD) (mm) measured by QCA and percentage restenotic area after six months.