Introduction/Purpose Atherosclerosis of the internal carotid artery remains a significant contributor to stroke morbidity and mortality. While patient risk factors have been identified to be associated with carotid restenosis after carotid stenting (CAS), conflicting theories exist on whether residual stenosis is an independent risk factor. To determine the long-term rate of radiographic restenosis after CAS for atherosclerosis, and the clinical, radiographic, and procedural predictors of in-stent restenosis.

Materials and Methods A single-center, prospectively maintained database was retrospectively reviewed for CAS procedures over a 12-year period. Patient demographic, procedural characteristics, radiographic and clinical details were noted. Comparison of baseline characteristics of patients with and without carotid restenosis were performed using chi-squared test for categorical variables and student t-test for continuous variables. Univariate and multivariate analyses were performed to determine risk factors associated with restenosis, defined as >70% on digital subtraction angiography.

Results 1017 consecutive carotid artery stenting (CAS) procedures were performed in 905 patients over the 12-year period, with 738 CAS procedures in 632 patients included after exclusion criteria. Overall restenosis rate was 17%, with a 14% restenosis rate at 2 years-time. Multivariable analysis demonstrated former/current smoking status (OR=2.1 [95%CI 1.2-3.9]), moderate contralateral stenosis (OR 3.0 [95%CI 1.4-6.7]), severe contralateral stenosis (OR3.0 [1.4-6.3]), and residual stenosis (OR 454 [95% 85-2413]) were associated with restenosis. AUC for the multivariable model was 0.78. Cut-point degree for residual stenosis was ~30%, where there was a 9% and 35% rate of restenosis in those less than, and greater than, 30% residual stenosis, respectively (figure 1).

Conclusion We present the largest single-center data in the US to date on carotid artery stenosis treated with CAS, and factors associated with restenosis. Residual in-stent carotid stenosis and smoking history were independent predictors. Maximizing treatment of initial stenosis within stent for carefully selected patients and aggressive smoking cessation education are important steps in preventing future carotid restenosis.

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Abstract P-001 Figure 1

Carotid restenosis after carotid arty tenting (%) by categories of degree of residual stenosis after initial procedure (a), and by cutpoint of 29% (b)

Disclosures P. Lai: None. K. Snyder: 2; C; Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. 4; C; Boston Scientific, Access Closure Inc, Niagara Gorge Medical.. A. Baig: None. W. Khawar: None. B. Donnelly: None. M. Siddiqi: None. M. Kruk: None. W. Jacoby: None. J. Davies: 1; C; NIH NINDS, NSF SBIR. 2; C; Medtronic; Honoraria. 4; C; Synchron, Cerebrotech, QAS.ai, RIST. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, and others. 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, and others. 6; C; National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; and others. E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, and others. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and others.