KAROTİD ARTER STENTLEME SONRASI GELİŞEN STENTİÇİ RESTENOZUN YENİ BİR ÖNGÖRDÜRÜCÜSÜ: CRP/ ALBUMİN ORANI The CRP/Albumin Ratio: A Novel Predictor of In-stent Restenosis After Carotid Artery Stenting
Abstract
ÖZET
Amaç: Çalışmamızda, karotid arter stentleme (KAS) işlemi öncesi bakılan C-reaktif protein/albumin oranının
(CAO) stent içi restenozu (SİR) öngördürme potansiyelini araştırmayı amaçladık.
Gereç ve Yöntem: Retrospektif olarak dizayn edilen bu çalışmaya tersiyer merkezimizde başarılı bir şekilde
karotid arter stentleme yapılan toplam 206 hasta alındı. İşlem öncesi her hastanın C-reaktif protein (CRP) ve
serum albumin değerleri çalışıldı. CAO değeri, CRP değeri serum albumin değerine bölünerek hesaplandı.
Çalışmanın primer sonlamın noktası takip sırasında gelişen SİR olarak belirlendi.
Bulgular: 206 hastanın ortalama 24.2 ± 1.5 ay takibi sonunda SİR toplam 34 (%16.5) hastada izlendi. SİR
gelişmeyen hastalarla karşılaştırıldığında, CAO, SİR gelişen hastalarda anlamlı olarak daha yüksek saptandı
(0.15 [0.2] vs. 0.99 [1.3], p < 0.01, sırasıyla). Çok değişkenli COX analizinde, CAO, SİR ‘un bağımsız öngördürücüsü
olarak saptandı (HR: 1.85, %95 CI: 1.29 – 2.64, p < 0.01). ROC eğrisi analizinde CAO değerinin > 0.53
olması, SİR ‘u %100 duyarlılık ve %97.1 özgüllük ile öngördürmekteydi (AUC) 0.98, p < 0.01).
Sonuç: Çalışmamızın sonuçları göstermiştir ki, inflamatuar bazlı yeni bir belirteç olan CAO KAS işlemi yapılan
hastaların takiplerinde gelişen SİR ‘un güçlü ve bağımsız bir öngördürücüsüdür. Hızlı ve kolayca bakılabilen
bu parametre, KAS işlemi yapılan hastalarda SİR gelişimini değerlendirmek için kullanılabilir.
Anahtar kelimeler: CAO; Stent içi restenoz; Karotis arter stentleme; İnflamasyon
ABSTRACT
Objective: The present study aimed to assess the predictive value of preprocedural C-reactive protein/
albumin ratio (CAR) for in-stent restenosis (ISR) after carotid artery stenting (CAS).
Materials and Method: In this retrospective study, 206 patients who underwent successful CAS procedure
in a tertiary heart centre were included. For each patient, both C-reactive protein (CRP) and serum albumin
were determined before the index procedure. The CAR was calculated by dividing serum CRP by serum
albumin level. The main end-point of the study was ISR during long-term follow-up.
Results: ISR developed in 34 (16.5%) out of 206 patients after a mean follow-up of 24.2 ± 1.5 months. The
CAR was significantly elevated in patients with ISR compared to those who were not (0.99 [1.3] vs. 0.15
[0.2], p < 0.01, respectively). In a multivariate Cox regression analysis, the CAR was an independent predictor
of ISR (HR: 1.85, %95 CI: 1.29 – 2.64, p < 0.01). A ROC curve analysis revealed that the optimal value
of CAR in predicting ISR was > 0.53 with a sensitivity of 100 % and a specificity of 97.1 % [area under curve
(AUC) 0.98, p < 0.001].
Conclusion: The present study demonstrated that CAR, a new inflammatory-based index, is a strong independent
predictor of ISR after CAS. As a simple and easily accessible parameter, this index may be used for
the assessment of ISR in patients who are treated with CAS.
Keywords: CAR; In-stent restenosis; Carotid artery stenting; Inflammation
References
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Abstract
References
- 1. Phan TG, Beare RJ, Jolley D, et al. Carotid artery anatomy and geometry as risk factors for carotid atherosclerotic disease. Stroke 2012; 43: 1596–1601. 2. Chaturvedi S and Sacco RL. How recent data have impacted the treatment of internal carotid artery stenosis. J Am Coll Cardiol 2015; 65: 1134–1143. 3. Brott TG, Halperin JL, Abbara S, et al. 2011 ASA/ACCF/ AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Stroke 2011;42:e464–e540. 4. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160–2236. 5. Cohen DJ, Stolker JM, Wang K, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy: results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol 2011; 58: 1557–1565. 6. Brajesh K Lal, Kirk W Beach, Gary S Roubin et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11:755–763 7. Lal BK, Hobson RW, Goldstein J et al. In-stent recurrent stenosis after carotid artery stenting: life table analysis and clinical relevance. J Vasc Surg. 2003; 38:1162–1168 8. de Borst GJ, Ackerstaff RG, Mauser HW, et al. Operative management of carotid artery in-stent restenosis: first experiences and duplex follow-up. Eur J Vasc Endovasc Surg. 2003; 26:137–140 9. Wholey MH, Wholey M, Mathias K, et al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv. 2000;50:160–167 10. Yadav JS, Roubin GS, Iyer S, et al. Elective stenting of the extracranial carotid arteries. Circulation. 1997; 95:376–381
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | March 25, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 1 |