Neointimal proliferation within carotid stents is more pronounced in diabetic patients with initial poor glycaemic state

Abstract

Aims/hypothesis. We studied the influence of initial hyperglycaemia on neointimal proliferation within carotid Wallstents. Methods. A total of 112 patients were followed by duplex sonography after carotid stenting for 24 months. Patients were assigned to three groups: non-diabetic subjects (group A) and diabetic patients, who were assigned according to their baseline HbA 1C values, to group B1 (HbA1c≤6.5%) or group B2 (HbA1c>6.5%). Results. At baseline the groups did not differ with respect to other vascular risk factors and residual stenosis on angiograms. The maximal thickness of the layer between the stent and the perfused lumen was measured at the duplex follow-ups. At 3 months the typical ultrasonic structure of the neointima was clearly discernible. From this point on, group B2 differed significantly (p<0.001) compared with B1 and A with respect to the maximal thickness of neointima and the time course of its ingrowth: group A vs B1 vs B2 was 0.51±0.39 vs 0.52±0.33 vs 0.56±0.35 at 3 months, 0.91±0.27 vs 0.90±0.38 vs 1.14±0.48 at 6 months, 1.02±0.24 vs 0.97±0.34 vs 1.21±0.44 at 12 months and 1.09±0.23 vs 1.10±0.31 vs 1.23±0.37 at 24 months. Conclusion/interpretation. Initial hyperglycaemia seems to be a predictor of more pronounced neointimal proliferation after carotid stenting independent of diabetes. As intimal hyperplasia is known to be responsible for stent restenosis, strict optimisation of the hyperglycaemic state should be aimed at before elective carotid artery stenting.