The Relationship Between Achilles Tendon Thickness and Instent Restenosis in Patients with Carotid Stents

Year 2024, Volume: 14 Issue: 2, 393 - 398, 28.06.2024

Cemalettin Yılmaz , Büşra Güvendi Şengör , Mehmet Hasan Özdil , Ahmet Ferhat Kaya , Lütfi Öcal , Nuri Havan , Ali Karagoz , Mehmet Vefik Yazıcıoğlu , Regayip Zehir

https://doi.org/10.33808/clinexphealthsci.1320825

Abstract

Objective: Considering that atherosclerosis and Achilles tendon thickening share common mechanisms, the aim of this study to reveal the relationship between Achilles tendon thickness (ATT) and carotid in-stent restenosis (ISR).
Methods: In this study, 89 patients who had carotid stenting for carotid artery disease at our institute between 2016 and 2020 were included. Subjects were divided into two groups as restenosis (+) and restenosis (-) based on the ultrasonographic and/or angiographic findings. The development of 50% or more restenosis in the carotid stent was defined as ISR. Bilateral ATT was measured for all patients who satisfied the inclusion criteria.
Results: In our study, 16 (17.9%) patients constituted the restenosis group and 73 (82%) the no-restenosis group. ATT values were similar between groups (4.90.8 vs 4.70.6, p=.27). However, in the marginal effect graphic, it has been demonstrated that the probability of carotid stent restenosis increases with the increase in the mean ATT. The probability of restenosis was 14% when the mean ATT value was 4.16 mm (mean -1 SD) and the probability of restenosis was 22% when the mean ATT value was 5.36 mm (mean +1 SD).
Conclusion: No significant difference was found in ATT between the restenosis and no-restenosis group, however, the probability of restenosis increased with increasing ATT. In addition, ultrasonographic measurement of ATT is an easy, inexpensive and safe method that can be used to identify patients at high risk for carotid stent restenosis.

Keywords

Carotid Artery Disease, Carotid Stent Restenosis, Achilles Tendon Thickness, Atherosclerosis, Cerebrovascular Disease

Project Number

yok

References

• Brott TG, Howard G, Roubin GS, Meschia JF, Mackey A, Brooks W, Moore WS, Hill MD, Mantese VA, Clark WM, Timaran CH, Heck D, Leimgruber PP, Sheffet AJ, Howard VJ, Chaturvedi S, Lal BK, Voeks JH, Hobson RW, CREST Investigators. Long-term results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med. 2016;374(11):1021-1031. DOI: 10.1056/NEJMoa1505215
• Bonati LH, Dobson J, Featherstone RL, Ederle J, van der Worp HB, de Borst GJ, Mali WPTM, Beard JD, Cleveland T, Engelter ST, Lyrer PA, Ford GA, Dorman PJ, Brown MM, International Carotid Stenting Study investigators. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: The International Carotid Stenting Study (ICSS) randomised trial. Lancet 2015;385(9967):529-538. DOI: 10.1016/S0140-6736(14)61184-3
• Eckstein HH, Ringleb P, Allenberg JR, Berger J, Fraedrich G, Hacke W, Hennerici M, Stingele R, Fiehler J, Zeumer H, Jansen O. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: A multinational, prospective, randomised trial. Lancet Neurol. 2008;7(10):893-902. DOI: 10.1016/S1474-4422(08)70196-0
• Barros P, Felgueiras H, Pinheiro D, Guerra M, Gama V, Veloso M. Restenosis after carotid artery stenting using a specific designed ultrasonographic protocol. Journal of Stroke and Cerebrovascular Diseases 2014;23(6):1416-1420. DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.002
• Tekieli Ł, Musiałek P, Kabłak-Ziembicka A, Trystuła M, Przewłocki T, Legutko J, Dzierwa K, MacIejewski D, Michalski M, Pieniązek P. Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS). Postepy Kardiol Interwencyjnej. 2019;15(4):465. DOI: 10.5114/AIC.2019.90221
• Lal BK, Beach KW, Roubin GS, Lutsep HL, Moore WS, Malas MB, Chiu D, Gonzales NR, Burke JL, Rinaldi M, Elmore JR, Weaver FA, Narins CR, Foster M, Hodgson KJ, Shepard AD, Meschia JF, Bergelin RO, Voeks JH, Howard G, Brott TG, CREST Investigators. Restenosis after carotid artery stenting and endarterectomy: A secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11(9):755-763. DOI: 10.1016/S1474-4422(12)70159-X
• Mousa AY, AbuRahma AF, Bozzay J, Broce M, Kali M, Yacoub M, Stone P, Bates MC. Long-term Comparative Outcomes of Carotid Artery Stenting Following Previous Carotid Endarterectomy vs De Novo Lesions. J Endovasc Ther. 2015;22(3):449-456. DOI: 10.1177/1526602815581597
• Clark DJ, Lessio S, O’Donoghue M, Tsalamandris C, Schainfeld R, Rosenfield K. Mechanisms and predictors of carotid artery stent restenosis: A serial intravascular ultrasound study. J Am Coll Cardiol. 2006;47(12):2390-2396. DOI: 10.1016/J.JACC.2006.01.076
• Kornowski R, Hong MK, Tio FO, Bramwell O, Wu H, Leon MB. In-stent restenosis: Contributions of inflammatory responses and arterial injury to neointimal hyperplasia. J Am Coll Cardiol. 1998;31(1):224-230. DOI: 10.1016/s0735-1097(97)00450-6
• Schwartz RS, Huber KC, Murphy JG, Edwards WD, Camrud AR, Vlietstra RE, Holmes DR. Restenosis and the proportional neointimal response to coronary artery injury: Results in a porcine model. J Am Coll Cardiol. 1992;19(2):267-274. DOI: 10.1016/0735-1097(92)90476-4
• Matsumoto H, Yako R, Masuo O, Hirayama K, Uematsu Y, Nakao N. A case of in-stent neoatherosclerosis 10 years after carotid artery stent implantation: Observation with optical coherence tomography and plaque histological findings. Neurol Med Chir (Tokyo). 2014;54(2):139-144. DOI: 10.2176/NMC.CR2013-0063
• Kitahara H, Nakayama T, Fujimoto Y, Kobayashi Y. Association between Achilles tendon xanthoma and severity of coronary artery disease in patients undergoing percutaneous coronary intervention. J Cardiol. 2020;75(6):654-658. DOI: 10.1016/j.jjcc.2020.01.002
• Kitahara H, Mori N, Saito Y, Nakayama T, Fujimoto Y, Kobayashi Y. Prevalence of Achilles tendon xanthoma and familial hypercholesterolemia in patients with coronary artery disease undergoing percutaneous coronary intervention. Heart Vessels. 2019;34(10):1595-1599. DOI: 10.1007/s00380-019-01400-6
• Hashimoto T, Minami Y, Kakizaki R, Nemoto T, Fujiyoshi K, Meguro K, Shimohama T, Tojo T, Ako J. Achilles tendon thickening is associated with disease severity and plaque vulnerability in patients with coronary artery disease. J Clin Lipidol. 2019;13(1):194-200. DOI: 10.1016/j.jacl.2018.10.007
• Mangili LC, Miname MH, Silva PRS, Bittencourt MS, Rocha VZ, Mangili OC, Salgado Filho W, Chacra AP, Jannes CE, Pereira AC, Santos RD. Achilles tendon xanthomas are associated with the presence and burden of subclinical coronary atherosclerosis in heterozygous familial hypercholesterolemia: A pilot study. Atherosclerosis. 2017;263:393-397. DOI: 10.1016/J.ATHEROSCLEROSIS.2017.04.025
• Oosterveer DM, Versmissen J, Yazdanpanah M, Hamza TH, Sijbrands EJG. Differences in characteristics and risk of cardiovascular disease in familial hypercholesterolemia patients with and without tendon xanthomas: A systematic review and meta-analysis. Atherosclerosis2009;207(2):311-317. DOI: 10.1016/J.ATHEROSCLEROSIS.2009.04.009
• Soslowsky LJ, Fryhofer GW. Tendon homeostasis in hypercholesterolemia. Advances in Experimental Medicine and Biology. Springer New York LLC; 2016:151-165. DOI: 10.1007/978-3-319-33943-6_14
• Setacci C, Chisci E, Setacci F, Iacoponi F, De Donato G. Grading carotid intrastent restenosis: a 6-year follow-up study. Stroke 2008;39(4):1189-1196. DOI:10.1161/STROKEAHA.107.497487
• Kiortsis DN, Argyropoulou MI, Tsouli SG, Xydis V, Elisaf MS. Correlation of Achilles tendon thickness evaluated by ultrasonography with carotid intima-media thickness in patients with familial hypercholesterolemia. Atherosclerosis 2006;186(1):228-229. DOI: 10.1016/J.ATHEROSCLEROSIS.2006.02.002
• Genkel V, Kuznetsova A, Lebedev E, Sinitskii A, Pykhova L, Shaposhnik I. Achilles tendon thickness is an independent predictor of carotid atherosclerosis and is associated with a carotid plaque burden. Angiology 2020;71(8):734-739. DOI: 10.1177/0003319720928226
• Mabuchi H, Tatami R, Haba T, Ueda K, Ueda R, Ito S, Karnetani T, Koizurni J, Miyamoto S, Ohta M, Takeda R, Takegoshi T, Takeshita H. Achilles tendon thickness and ischemic heart disease in familial hypercholesterolemia. Metabolism 1978;27(11):1672-1679. DOI: 10.1016/0026-0495(78)90289-5
• Hirobe K, Matsuzawa Y, Ishikawa K, Tarui S, Yamamoto A, Nambu S, Fujimoto K. Coronary artery disease in heterozygous familial hypercholesterolemia. Atherosclerosis 1982;44(2):201-210. DOI: 10.1016/0021-9150(82)90114-9
• Wang B, Zhang Q, Lin L, Pan LL, He CY, Wan XX, Zheng ZA, Huang ZX, Zou CB, Fu MC, Kutryk MJ. Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia. Lipids Health Dis. 2018;17(1):131. DOI: 10.1186/s12944-018-0765-x
• Illingworth DR, Cope R, Bacon SP. Regression of tendon xanthomas in patients with familial hypercholesterolemia treated with lovastatin. South Med J. 1990;83(9):1053-1057. DOI: 10.1097/00007611-199009000-00019
• Tsouli SG, Xydis V, Argyropoulou MI, Tselepis AD, Elisaf M, Kiortsis DN. Regression of Achilles tendon thickness after statin treatment in patients with familial hypercholesterolemia: An ultrasonographic study. Atherosclerosis 2009;205(1):151-155. DOI: 10.1016/j.atherosclerosis.2008.10.032
• Akturk M, Ozdemir A, Maral I, Yetkin I, Arslan M. Evaluation of achilles tendon thickening in type 2 diabetes mellitus. Experimental and Clinical Endocrinology and Diabetes 2007;115(2):92-96. DOI: 10.1055/s-2007-955097
• Khor BYC, Woodburn J, Newcombe L, Barn R. Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: A systematic review. J Foot Ankle Res. 2021;14(1). DOI: 10.1186/S13047-021-00475-7