A Study Of Relationship Between The Level Of Serum Hs-CRP And Restenosis After Carotid Artery Stent Implantation

Part Ⅰ The change of serum hs-CRP before and after CAS procedureObjective:We want to study the relationship between the hs-CRP level and the catotid stenosis, and the change of hs-CRP before and after the carotid artery stenting(CAS) procedure.Methods:From June2009to October2011, we selected the patients in the Nanjing Stroke Register Progrem(NSRP) who undergo the CAS. Indications to CAS are the symptomatic patients with50%or greater stenosis and asymptomatic patients with70%or greater stenosis. The exclusion criteria includes as follow:cannot tolerate with treatment of antiplatelet or anticoagulation; cannot tolerate operation with serious heart, liver or renal insufficiency; uncontrolled infection;allerge to contrast agent; intracranial bleeding within3months;subject to massive cerebral infraction or visceral hemorrhage;patients who have coagulation disorder;operation approach is difficult and stent cannot placed accurately. Before operation,patients will be gived aspirin100mg per day and clopidogrel75mg per day.If patients have to do emergency operation,the3days’ drug have to be given before6h.Before the operation,benzodiazepine leather drugs were used to release anxiety.Carotid stenosis rate was measured and calculated using North American Symptomatic Carotid Endarterectomy Trial(NASCET).All stent implantations were performed by the doctor who had experience in the carotid artery interventions.All patients received orally administered aspirin(100mg/d) and clopidogrel(75mg/d)6months after CAS,and aspirin was administered indefinitely.The level of serum hs-CRP were determined in the patients treated with CAS before stent implantation,and12h、7days、3months、6months after stent implantation.Statistics:All data were stored and analyzed using the SPSS statistical package13.0(SPSS Inc,Chicago,IL,U.S.A).Descriptive data are expressed as mean±standard deviation (x±s).For the comparison of quantitative data of the before and after treatment groups,the One-way ANOVA test was applied. A p value less than0.05was considered statistically significant.Results:A total of123patients were undergone CAS,4patients with infection,13patients with arteritis,6patients with infection in follow-up,16patients loss follow-up were excluded.58men patients and26women patients,age from44-81(average age63.5±11.2) were in our study.Before the CAS,we defined three groups people,carotid stenosis50-70%,70-90%,70-90%.The CRP level were6.97±0.75mg/L;7.92±0.61mg/L;8.87±0.45mg/L.We found that the higher the CRP level,the higher the carotid stenosis.The12h CRP level after CAS was higher than before the CAS (P<0.001), The6months CRP level after CAS was lower than before the CAS (P<0.001).Conclusions:The inflammation plays an importment role in atherosclerosis.The CRP level was elevated after CAS,and because of endometrial remodeling,the CRP level was lower than before the CAS. Part II To study the relationship between hs-CRP and the restenosis after CASObjective:To study the relationship between hs-CRP and the restenosis after CAS.Methods:We selected the patients who undergone CAS in Nanjing General Hospital and back to received DSA to check the stent.Base data was collected,including abdominal perimeter,hypertension history,diabetes history,smoking.The hs-CRP level,blood lipids,blood glucose were detected in6o’clock before the operation in the morning. Carotid stenosis rate was measured and calculated using North American Symptomatic Carotid Endarterectomy Trial(NASCET).Recurrent carotid artery stenosis is defined as the reappearance of a stenosis with a diameter reduction of>50%in the stented internal carotid artery.In this study,we defined stent restenosis as a diameter reduction of>30%. Statistics:All data were stored and analyzed using the SPSS statistical package13.0(SPSS Inc,Chicago,IL,U.S.A).Descriptive data are expressed as mean±standard deviation (x±s). For the comparison of quantitative data of the groups, the Mann-Whitney U test was applied.Multivariate analysis was performed using unconditional Logistic regression analysis.A p value less than0.05was considered statistically significant.Results:84patients who undergone CAS were back to received DSA to check the stent.15patients(24%).In-stent restenosis developed in15carotids(24%),three restenosis>50%,tweleve restenosis>30%.The glucose is higher in restenosis group than in non-restenosis group(P<0.001).Before angioplasty,after angioplasty, length of the stent and diameter of the stent have no relationship between the restenosis group and non-restenosis group.The serum level of hs-CRP after stent implantion12h was higher than before(P<0.001),and after6months,the level was lower than before the operation(P<0.001). Δhs-CRP (the difference of hs-CRP between before and6months after stent implantation) in restenosis group is lower than non-restenosis group(P<0.001).As a result of multivariate regression analysis, diabetes (OR=1.840, P=0.024), Ahs-CRP (OR=2.392, P<0.001) were risk factors contributed to restenosis.Conclusions:The inflammation plays an importment role in atherosclerosis.The hs-CRP elevated after CAS and in process of the endometrial pathological.The change of the hs-CRP can predict the restenosis after CAS.