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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
ORIGINAL ARTICLES SELECTED PAPERS FROM SICVE NATIONAL CONGRESS 2009
Italian Journal of Vascular and Endovascular Surgery 2010 September;17(3):163-7
The impact of diabetes mellitus on results and neointimal progression of carotid artery stenting
Faggioli G., Mauro R., Freyrie A., Gargiulo M., Pini R., Serra C., Stella A.
Department of Vascular Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
Aim. Diabetes mellitus (DM) increases the risk of cerebrovascular disease in the general population and its influence in carotid artery revascularization is debated, however its impact in carotid artery stenting (CAS) has been scarcely investigated. Aim of this study is the assessment of DM impact on CAS results both perioperatively and at 6 months in relation also with the progression of the neointimal layer over the stent.
Methods. Patients with symptomatic and asymptomatic carotid disease undergoing CAS with distal protection were divided in GI (DM) and GII (no DM) and evaluated in term of epidemiology, percent of carotid stenosis, type of carotid plaque (homogenous vs. dishomogenous), contralateral carotid disease, aortic arch atherosclerosis, type of stent deployed (closed vs. open cells), technical success, early neurological outcome. Follow-up was at 3, 6, 12 months and yearly thereafter by duplex scanning and clinical examination. Results were analyzed by Fisher’s and Wilcoxon tests for differences across groups for categorical and continuous variables respectively and logistic regression analysis. A subgroup of consecutive patients was also examined 6 months after CAS by high resolution duplex scanning with 3D reconstruction to identify possible stent coverage by a neointimal layer, assessing the percentage of stent surface coverage.
Results. In 427 CAS examined, 112 patients (26%) were in GI and 315 (74%) in GII. There was no significant difference in the two groups in any of the categories considered except for age (age>80 years: 26% vs. 74%, OR 0.95 for one-year increment) and for coronary artery disease (48% vs. 35% P=0.011, OR 1.74). No deaths occurred in this series. Technical success (92% vs. 89 %, P=0.4) and major complication rate (3% vs. 2% P=0.2) were similar in the two groups. Cerebral haemorrhage occurred in two patients after few weeks (one in each group) and one patient in GII developed a significant asymptomatic restenosis after one year.
In the 110 patients (22 in GI and 88 in GII) analyzed for stent coverage, a complete neointimal layer covered the stent in 10 GI patients (45%) vs. 40 in GII (45%, P=NS). The progression of this new layer was independently and inversely associated with age (1-year increment OR 1.06).
Conclusions. Although patients with DM and cerebrovascular disease are significantly younger and with higher incidence of CAD compared with other pts, they show early and long term results after of CAS similar to those of patients without DM. Stent coverage by neo-intimal layer is similar in the two groups. CAS indication in patients with DM should follow accepted guidelines for carotid revascularization.