Relations between plasma von willebrand factor or endothelin-1 and restenosis following carotid artery stenting

This study was designed to investigate the relation between plasma von Willebrand factor [VWF] or endothelin-1 [ET-1] and post-carotid artery stenting [CAS] restenosis. Plasma levels of VWF and ET-1 were measured in 61 patients [36 males, mean age 64.4 +/- 6.8 years] before and after CAS. The mean follow-up time was 13.8 +/- 1.7 months [range, 6-63]. In-stent restenosis was defined as a >10% narrowing of the vascular lumen with or without ischemic symptoms following CAS. In-stent restenosis was identified in 14 [23%] patients, including 3 with >50% restenosis. In the restenosis group, mean VWF and ET-1 levels at 2 weeks, 1 and 6 months after CAS were higher than the baseline levels [p < 0.05 or p < 0.01]. Mean levels of VWF and ET-1 in the restenosis group were higher than in the non-restenosis group within 6 months after CAS [p < 0.05 or p < 0.01]. Persistent elevation in plasma VWF and ET-1 within the first 6 months of CAS was found in patients with in-stent restenosis

Changes of endothelial function and its relation with restenosis in patients performed carotid artery stenting / 中华神经医学杂志

Objective To explore the changes of levels of von willebrand (vWF) and endothelin-1 (ET-1) and their relations with restenosis in patients performed carotid artery stenting (CAS).Methods The levels of vWF and ET-1 in 67 patients were measured before CAS and 1 h, 2 w, 1 and 6months, and 1 y after the stenting. All the patients were divided into restenosis group and non-restenosis group according to the examining results of cervical CTA 1 y after CAS. Results In the follow-up survey, 1 patient was died and 4 were out of touch. Fourteen patients had restenosis of different degrees;the restenosis rates of 3 patients was more than 50 percent. The level of vWF 1 h and 6 months after CAS and the level of ET-1 1 h, 2 w and 6 months after CAS were increased rapidly as compared with those before CAS (P<0.05). As compared with those in the on-restenosis group, the level of vWF 1 h, 2 w and 6 months after CAS and the level of ET-1 1 h, 2 w, 1 and 6 months after CAS in the restenosis group were obviously increased (P<0.05). Conclusion The levels of vWF and ET-1 increase continually in a short term (within 2 weeks) after CAS, and increase once again 6 months after CAS which increases the risk of restenosis.Monitoring the levels of vWF and ET-1 may be of great value in judging long-term prognosis.

Clinical interference and follow-up studies in patients with symptomatic carotid artery totalocclusion / 中华神经医学杂志

Objective To evaluate the effects of artery-interventional therapy and drug treatment on patients with symptomatic carotid artery total occlusion,and observe the follow-up results of cerebrovascular events after clinical interference.Methods According to patient′s intention,62patients with symptomatic carotid artery total occlusion,admitted to our hospitals from February 2004 to January 2009,were divided into artery-interventional therapy group(n=21)and drug treatment group (n=41).In the artery-interventional therapy group,patients were given revascularization of internal carotid by endovascular intervention.In the drug treatment group,patients were given aspirin,clopidogrel and statins.The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Scale(mRS),and Rank sum test was employed to compare the differences of mean rank of the 2 groups; the minor end-point outcome was the cardiovascular events,and Kaplan-Meier method and multivariate Cox regression were employed to analyze the median time and independent risk factors.Results During the 3,6 and 9 months,1 and 2 years of follow-up,mRS average ranks in the artery-interventional therapy group were statistically lower than those in the drug treatment group(P＜0.05).The median times of recurrence of cardio-cerebrovascular events in the artery-interventional therapy group and drug treatment group were(17.42±1.20)months(95％CI:15.07-19.76)and(19.43±1.51)months(95％CI:16.48-22.38),respectively,and Kaplan-Meier analysis showed no significant difference(P＞0.05).Survival Cox regression analysis showed that independent factors of cardio-cerebrovascular events were smoking(RR=3.189,95％CI:1.020-9.968,P=0.046),diabetes(RR=2.717,95％CI:1.113-6.631,P=0.028),and baseline NIHSS scores(RR=2.984,95％CI:1.049-8.485,P=0.040),but treatment methods(artery-interventional therapy and drug treatment)were not independent factors(RR=1.191,95％CI:0.430-3.296,P=0.737).Conclusion Artery-interventional therapy is superior to drug therapy in achieving better functional prognosis; however,the 2-year-follow-up shows that the artery-interventional therapy can not reduce the occurrence of cardio-eerebrovascular events.Smoking,diabetes and baseline NIHSS scores are independent factors of recurrence of cardio-cerebrovascular events.

Dynamic changes of the levels of inflammation factors after carotid artery stenting and their relation to restenosis in patients with transient ischemic attack / 中华神经医学杂志

Objective To explore the changes of the levels of Interleukin-6 (IL-6), tumor necrosis factor a (TNF-α) and c-reactive protein (CRP) after carotid artery stenting (CAS) and their relation to restenosis in patients with transient ischemic attack. Methods The patients were divided into group A (with 1 stenting and 1 lesion, n=38) and group B (with 2 stenting and 2 lesions, n=29) according to the pathologic changes and complicated degrees of CAS, and all the patients were divided into restenosis group (n=14) and non-restenosis group (n=48) according to the examination results of cervical CTA 1 y after CAS. The levels of EL-6, TNF-α and CRP were measured before CAS and 1 h, 2 w, 1 and 6 mon, and 1 y after stents. The level of CRP was measured by enhanced immunoturbidirnetic assay, and the levels of IL-6 and TNF-a were measured by radioimmunoassay. Results to the follow-up survey, 1 died and 4 were lost. Fourteen had restenosis of different degrees. The restenosis rate more than 50 percent was noted in 3 patients. Compared to those before CAS, the levels of CRP, IL-6 and TNF-α were increased rapidly after CAS (P<0.05). Compared to those in the group A, the levels of CRP, IL-6 and TNF-α in the group B 1 h, 2 w and 6 mon after CAS were obviously increased (P<0.05). Compared to those in the non-restenosis group, the levels of CRP, IL-6 and TNF-α in the restenosis group 1 h, 2 w and 6 mon after CAS were obviously increased (P<0.05). Conclusion The levels of IL-6, TNF-α and CRP increased rapidly after CAS, then reduced gradually and increased once again 6 months after CAS, which was notable in restenosis group. They can be the reference indexes of the forecast for early restenosis.