CT angiography imaging in the follow-up of patients with carotis artery stenting

Stroke continues to be one of the most important causes of morbidity and mortality worldwide. The incidence of stroke and the risk of stroke related death increase with age, and approximately 20% of ischemic stroke and transient ischemic attacks (TIA) occur due to atherosclerotic carotid artery stenosis. In cases with clinically and hemodynamically significant carotid stenosis, surgical carotid endarterectomy (CEA) or carotid artery stenting (CAS) is recommended as the classical treatment. Today, color Doppler ultrasonography (RDUS) and computed tomography angiography (CTA) are mostly used in the follow up of patients who have been treated with CAS. In this study, our aim is to evaluate the development of stent patency, neointimal hyperplasia and restenosis with CTA in the follow up of patients who underwent CAS treatment at Mersin University Interventional Radiology Unit, as well as to investigate the causes that contribute to the development of neointimal hyperplasia and restenosis, and to compare the results with the studies in the literature. In our study, 96 patients who underwent stenting due to carotid artery stenosis at Mersin University Faculty of Medicine, Department of Radiology and underwent CTA examination between September 2010 and December 2022 were included in the study, and a total of 101 stented carotid arteries, 5 bilaterally, were evaluated. Patient data were reviewed retrospectively. All cases were investigated in terms of systemic diseases and smoking. Patients who developed neointimal hyperplasia were determined on the obtained CTA images, and the degree of stenosis was calculated using the NASCET method. The relationship between the demographic characteristics of the patients, risk factors and the characteristics of the stent used with the development of neointimal hyperplasia and restenosis was investigated. Neointimal hyperplasia developed in 67 (66.3%) of 101 stents and restenosis developed in 24 (23.8%) of 101 stents in the follow up of patients with stent implants. It was determined that the rate of smoking was higher in patients who developed neointimal hyperplasia (p=0.048). It was determined that the presence of diabetes mellitus also had a positive effect on the development of neointimal hyperplasia (p=0.027) and the diagnosis of diabetes mellitus was found to be higher in patients who developed restenosis compared to patients who did not develop restenosis (p=0.039). However, it was determined that the use of open cell nitinol stent was higher in arteries with neointimal hyperplasia (p<0.001). In our study, we found that diabetes mellitus and smoking increased the development of neointimal hyperplasia. We found that nitinol stent was used at a higher rate in arteries with neointimal hyperplasia; We determined that open cell stent design is effective in the formation of neointimal hyperplasia. We found that the diagnosis of diabetes mellitus was higher in patients who developed restenosis compared to patients who did not develop restenosis. The obtained data should be investigated with more comprehensive studies.