| Objective This study was undertaken to investigate the incidence of local vascular complications(LVC) after carotid artery stenting(CAS), to identify some predictors of LVC, and to provide evidence for a more accurate clinical choice of the appropriate patients, treatment and prevention of CAS complications.Methods 84 patients(77 men and 7 women, age 67.1±8.9 years) who underwent CAS from September 2011 to July 2015 in our hospital were involved in this study. 19 patients had cerebral infarction history, 63 patients hypertension, 41 patients coronary heart disease, 5 patients atrial fibrillation, 36 patients diabetes, 30 patients hyperlipidemia, 15 patients high homocysteine,and 17 patients smoking history. Parameters of ultrasound examination on arotid artery plaque were collected preoperatively. A total of 84 carotid stents were implanted, of which 46 were left and 38 right. 16 cases also underwent vertebral artery stenting. After operation, all the patients were followed up by carotid color doppler ultrasound for average time of 12.6 months(1-42 months).The incidence of local vascular complications was analyzed, and the aspects of plaque location, scope, quantity, echo, stability, stenosis were investigated to find possible risk factors for LVC.Results CAS was perfomed in 84 patients, and postoperative overall incidence of vascular complications was 64.3%(54 cases), thrombosis in 8cases(9.5%), endometrial hyperplasia in 20 cases(23.8%), incomplete expansion in 36 cases(42.9%), restenosis in 8 cases(9.5%), stent effect in 17cases(20.2%), the residual leakage in 2 patients(2.4%). No stent migration,breakage and occlusion was found. When the external carotid artery plaque existed, the incidence of all LVCs was relatively increased. The thrombosis rate in external carotid artery plaque group was 20.8%, which is higher than that of 5.1% in no external carotid artery plaque group, and the difference was statistically significant(P=0.041). The incidence of incomplete dilatation in single plaque was 68.8%, while the multiple patches was 36.8%, and the difference was statistically significant(p=0.026). The incidence of LVC in the basal calcified plaque was higher than that in the non basal calcified plaque,but the difference was not statistically significant. The original diameter of the restenosis group was 6.40±1.15 mm, and the non-restenosis group was 7.55±1.18 mm, and the difference was statistically significant(p=0.011). The average PSV in the restenosis group was 383.38cm/s, which was 238.61cm/s for the non-restenosis group, the differences have statistical significance(P=0.028). ROC curve showed that PSV≥428cm/s predicted ISR by sensitivity of 75.2%, specificity of 92.1%, and area under curve was 0.763. Logistic regression shows that the above factors have not entered the regression equation.Conclusion Carotid Doppler Ultrasonography(CDU) can discover a variety of local vascular complications and follow up to observe the progress of these LVC. It is an important method for CAS postoperative follow-up, and regular follow-up can help in the early detection of the LVC. Basal calcified plaque, smaller original diameter, PSV ≥ 428cm/s may be connected with ISR rate increasement. Intimal hyperplasia may not be the direct cause of the occurrence of ISR, while stent deformation, thrombosis may be more closely related to ISR. Early postoperative intimal hyperplasia may promote the occurrence of other local vascular complications. Carotid artery plaque assessment should be paid more attention, especially when multiple plaques exist, to make sure the location and boundary of the plaques, to determine the position of stent placement, and to avoid incomplete coverage, delay the progression of endometrial hyperplasia, reduce thrombosis, and then to reduce the risk of ISR. Basal calcified plaque and external carotid artery plaque may Lead to an increased risk of the occurrence of LVC after CAS, so for such patients the appropriate treatment should be chosen more carefully. |
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