Abstract：Objective To analyze the influencing factors of residual stenosis after carotid artery stent implantation.Methods Data of 152 patients with carotid artery stenosis (173 stents in total) who received carotid artery stent implantation in Dongguan People′s Hospital from February 2016 to February 2019 were retrospectively analyzed. Carotid angiography and color Doppler flow imaging (CDFI) were performed within 2 weeks before surgery, and CDFI was performed within 7 days after surgery. Patients were divided into residual stenosis group (n=36) and non-residual stenosis group (n=116) according to whether residual stenosis occurred after carotid artery stent implantation. The incidence of residual stenosis after carotid stenting was calculated. The clinical data and therapeutic effect of patients in residual stenosis group and non-residual stenosis group were compared. The influence of different structure characteristics of carotid artery stenosis on the incidence of residual stenosis after carotid stent implantation were analyzed. Multivariate Logistic analysis was used to investigate the risk factors for residual stenosis after carotid artery stenting. Results In 152 patients, the incidence of residual stenosis after carotid stenting was 23.68% (36/152), and 50 stents were inserted. The prevalence of hypertension in the residual stenosis group was 75.00%, higher than that in the non-residual stenosis group (64.66%), with a statistically significant difference (P<0.05). The total effective rate of the residual stenosis group was 97.22%, higher than that of the nonresidual stenosis group (81.90%), and the difference was statistically significant (P<0.05). There were no statistically significant differences in the incidence rates of residual stenosis after carotid artery stent implantation among patients with different stent locations, echo levels, and plaque calcification (P>0.05). Patients with preoperative vascular diameter <1.0 mm, heterogeneous echogenic plaque, surface calcification plaque, irregular plaque, and high grade of preoperative carotid artery contrast-enhanced ultrasound had higher incidence of residual stenosis after carotid stent implantation, and the differences were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that hypertension (β=0.38, OR=1.48, 95%CI=0.90-2.38), preoperative vascular diameter < 1.0 mm (β=0.46, OR=1.60, 95%CI=1.05-2.43), surface calcified plaque (β=0.92, OR=2.54, 95%CI=1.46-4.48), irregular plaque (β=2.17, OR=9.01, 95%CI=5.20-15.58), and high grade of preoperative carotid artery contrast-enhanced ultrasound (β=0.65, OR=1.24, 95%CI=1.15-2.77) were risk factors for residual stenosis after carotid stent implantation (P<0.05). Conclusion Carotid stenosis in patients with vascular structure characteristics (such as preoperative blood vessel diameter, surface calcified plaque, irregular plaques, preoperative carotid ultrasound imaging classification, etc.) are the carotid stent implantation factors that influence the incidence of residual stenosis after carotid artery stent implantation. Therefore, it is recommended to select an appropriate way to treat patients with carotid artery stenosis in combination with imaging features.
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