Diabetes mellitus (DM) increases the risk of cerebrovascular disease (CVD) 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. We evaluated the impact of DM on CAS results and on the progression of the neointimal layer over the stent.
Methods
Patients with symptomatic and asymptomatic CVD 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, contralateral carotid disease, aortic arch atherosclerosis, type of stent, technical success and early neurological outcome. Follow-up was at 3, 6, 12 months and yearly thereafter by clinical and duplex examination. Results were analyzed by Fisher's and Wilcoxon tests, logistic regression and life table analysis. A subgroup of consecutive patients was also examined by high resolution duplex scanning with 3d reconstruction at the same intervals to identify possible stent coverage by a neointimal layer, assessing the percentage of stent surface coverage.
Results
In 427 CAS, 112 pts (26%) were in GI and 315 (74%) in GII. The only significant differences in the two groups were found in age (>80 years: 26% vs. 74%, OR 0.95 for 1-year increment) and 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. Cerebral haemorrhage occurred in 2 patients after few weeks (one in each group); one patient in GII developed a significant asymptomatic restenosis at 1 year. In the 110 pts (40 in GI, 40 in GII) analyzed for stent coverage a complete neointimal layer over the stent in 16 GI patients (40%) vs. 18 in GII (46%, 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 CVD 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.
University of Bologna, Bologna, Italy
Author Disclosures: G. Faggioli, None; M. Ferri, None; A. Freyrie, None; M. Gargiulo, None; C. Serra, None; A. Stella, None.
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