Preoperative Inflammatory Status Is Not Associated with Primary Patency of Drug-Eluting Stents Placed in Tibial Vessels
Kenenth R. Nakazawa, Shravani Pathak, Rami O. Tadros, Robert Lookstein, Peter L. Faries, Ageliki G. Vouyouka.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
OBJECTIVES: We had previously determined that the patency of bare metal stents in femoropopliteal vessels is strongly and negatively associated with elevated preoperative white blood cell, platelet, and neutrophil counts (1). Here we aimed to evaluate the impact of preoperative inflammatory status, as determined by complete blood count (CBC) test parameters, on 12-month patency of drug-eluting stents placed in tibial vessels.
METHODS: We retrospectively analyzed baseline clinical and angiographic data among 64 patients (median age: 73 years, 41% females) from 2008-2017 at the Mount Sinai Hospital with preoperative CBC test values and information of patency for at least 12 months after first-time placement of everolimus eluting stents in tibial vessels. The primary endpoint was loss of primary patency, defined by a Doppler velocity ratio ≥2.5:1, computed tomographic angiography demonstrating ≥50% luminal narrowing within the stent, or re-intervention.
RESULTS: During a median follow-up of 22 months, 47 patients (73%) had in-stent restenosis (ISR) within 12 months. There were no significant differences in preoperative blood counts among patients who had ISR within 12 months vs those who had stents that remained patent for longer (Table 1). There were also no associations for other factors such as age, sex, lesion type, number of stents placed, total stent length, vessel runoff, adjunct procedures, statins, antiplatelet therapy, presence of diabetes, critical limb ischemia, critical limb ischemia, diabetes, smoking history, coronary artery disease, congestive heart failure, chronic occlusive pulmonary disease, and end stage renal disease (Table 1).
CONCLUSIONS: Unlike for bare-metal femoropopliteal stents, routine pre-procedural tests that determine baseline inflammatory status may not provide strong clinical utility in risk stratifying for ISR after drug-eluting stents are placed in tibial vessels. Further investigation is needed to better Identify which patients with tibial disease will respond optimally to stenting or other percutaneous interventions.
(1) Nakazawa et al. “Preoperative inflammatory status as a predictor of primary patency after femoropopliteal stent implantation.” Journal of Vascular Surgery 2017.
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