Society for Cardiovascular Angiography and Interventions

Society for Cardiovascular Angiography and Interventions

Issue: June 2013
May 09, 2013
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CREST substudy: Angioplasty after carotid stent deployment lowers restenosis risk

Issue: June 2013
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A CREST substudy presented as late-breaking data at the Society for Cardiovascular Angiography and Interventions Scientific Sessions suggests that angioplasty following stent deployment may lower restenosis rates in patients who undergo carotid artery stenting. However, there was a nonsignificant trend that showed a higher rate of periprocedural stroke among those who received this treatment.

Currently, the decision to perform post-stent deployment angioplasty (post-SDA) is operator dependent and often influenced by the interpretation of the degree of residual stenosis based on post-stent deployment angiography, according to the researchers. This led Mahmoud Malas, MD, and investigators of this retrospective substudy to evaluate whether post-SDA in patients randomly assigned to receive a carotid stent is associated with increased post-procedure adverse events.

Among the 1,113 patients who received carotid artery stenting (CAS) in CREST, 13 were excluded in the present study for not receiving CAS within 30 days of randomization. From the remaining cohort, 69 patients underwent pre-SDA only, 344 underwent post-SDA only, and 687 underwent both pre- and post-SDA.

There was one reported periprocedural stroke in the pre-SDA only group compared with 19 periprocedural strokes in the post-SDA only group (1.5% vs. 5.5%; multivariate HR=3.7; P=.26). Although this difference did not reach statistical significance, Malas and researchers wrote in the abstract that it may be possible that post-SDA increases the risk for periprocedural stroke, although it is uncertain “because of the small numbers of periprocedural strokes in the pre-SDA only and the post-SDA only groups.”

However, when they examined the risk for restenosis at 2 years, a statistically significant trend emerged that favored the post-SDA group (3.7% vs. 10.3%; multivariate HR=0.36; P=.02).

No differences were reported in periprocedural MI or death between groups.

For more information:

Malas M. LBCT. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 8-11, 2013; Orlando, Fla.

Disclosure: The researchers report no relevant financial disclosures.