Abstract 14783: Elevated Levels of pre-Procedural Lipoprotein(a) are Associated with Restenosis after Carotid Artery Stenting
Objectives: Lipoprotein(a) is known as an atherogenic lipoprotein. Enhanced Lipoprotein(a) [Lp(a)] is controversly discussed as risk factor for major atherosclerotic events like stroke or myocardial infarction. The purpose of this study was to evaluate the association of high plasma Lp(a) levels and in-stent restenosis in carotid artery stent (CAS) patients.
Methods: 100 consecutive patients (108 CAS) were enrolled in this prospective register. Before CAS, after day1 and month 1, 3, 6, 12, 24 and 36 lab testing and duplex ultrasound of the carotid artery were performed.
Results: Primary patency rate of CAS after 36 month was 87.5%. 16 hemodynamic relevant in-stent restenosis of the carotid arteries occurred after a mean of 11.2 month (CI95%: 4.8-17.5). 11 patients died during follow up period including one fatal cardiovascular event and one fatal stroke due to atherosclerotic vessel disease. In patients who presented with hemodynamic in-stent restenosis of the carotid artery Lp(a) serum concentration was significantly higher at baseline (174.8 vs 78 nmol/l; p= 0.001) and at day 1 (147 vs 87.5 nmol/l; p= 0.038) after stenting. Intima media thickness (IMT), measured at baseline, was the same between patients who developed an in-stent restenosis and patients who did not (bl: 0.9 vs 1.0mm, p=ns). A significant increase of IMT was observed at day 1(2.6 vs 1.4mm, p=0.02),month 1(3.4 vs 1.6mm, p=0.04) and 3 month (2.7 vs 1.3mm, p=0.007) after CAS in patients who developed instent restenosis of the carotid artery. IMT measurements of both groups did not differ significantly after 6, 12, 24, or 36 month.
Discussion: The results of this study suggest that elevated pre-procedural Lp(a) serum levels are predictive for in-stent restenosis in CAS patients. Because of the initial increase of the IMT in patients with in-stent restenosis we believe that an elevated inflammatory response of the vessel wall of this patients mediated through high Lp(a) levels is responsible for restenosis of stented carotid arteries. Further studies to determine the exact role of Lp(a) in in-stent restenosis have to be done.
- © 2011 by American Heart Association, Inc.