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VESS Paper Session

VESS08 - Rates of Progression of Carotid In-Stent Stenosis and Clinical Outcome

Wednesday, June 15, 2022
2:17 PM – 2:30 PM EDT
Objectives: We previously reported the incidence of ≥50% and ≥80% carotid in-stent stenosis. This study will analyze the rates of progression of in-stent stenosis and clinical outcome at later follow-up.

Methods: This is a retrospective analysis of prospectively collected data of 450 transfemoral carotid artery stentings at a later follow-up (a mean of 70 months). Progression of in-stent stenosis was defined as advancing to a higher severity of disease, i.e. < 50% to ≥50% or ≥50% to ≥80%. A Kaplan Meier Analysis was used to estimate the rate of progression from < 50% to ≥50%, ≥50% to ≥80%, overall rates of ≥50% and ≥80% in-stent stenosis, and survival at 1, 3, 5, and 10 years.

Results: At a mean follow-up of 70.3 months (range: 1-222 months), 121/446 (27%) had ≥50% and 39 (8.7%) had ≥80% in-stent stenosis. 82/406 (20.2%) of those that were normal or < 50% in-stent stenosis progressed to ≥50% in-stent stenosis at a mean of 51.7 months (range: 1-213) and 14/121 (11.6%) of those with ≥50% stenosis progressed to ≥80% at a mean of 33.6 months (range: 6-89 months). Two out of 14 (14.3%) of those that progressed from ≥50% to ≥80% had transient ischemic attacks (TIA), while the remaining patients were asymptomatic. Nine out of 39 patients (23%) with ≥80% in-stent stenosis had neurological events (eight TIAs and one contralateral stroke). Rates of freedom from < 50% to ≥50% in-stent stenosis progression were 93%, 85%, 78%, and 66% at 1, 3, 5, and 10 years (Figure 1); and for progression from ≥50% to ≥80% in-stent stenosis were 89%, 81%, and 77% at 1, 3, and 5 years, respectively (Figure 2). The overall rates of freedom for ≥50% in-stent stenosis were 86%, 77%, 71%, and 59%; and for ≥80% in-stent stenosis were 96%, 93%, 91%, and 84%; and the survival rates were 95%, 80%, 63%, and 31% at 1, 3, 5, and 10 years, respectively.

Conclusions: The rates of progression of carotid in-stent stenosis were modest, but had a low incidence of neurological events. Therefore, the utility of post-carotid artery stenting duplex surveillance must be re-evaluated.