Gökhan Demirci1, Ahmet Anıl Şahin2, Mehmet Altunova1, Tuğba Aktemur1, Meltem Tekin1, Mustafa Yıldız1, Mehmet Ertürk1

1Department of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
2Department of Cardiology, İstinye University, Liv Bahceşehir Hospital, İstanbul, Türkiye

Keywords: Atherosclerosis; CHADS2; peripheral arterial disease.


Objectives: Percutaneous intervention to aortoiliac occlusive disease (AIOD) is an approved choice of treatment instead of open surgery. However, despite improvement stent technology, in-stent restenosis (ISR) still remains a potential problem, especially in long-term follow-up of these patients. CHADS2 score is mainly a risk stratification tool for atrial fibrillation; however, it is found to be associated with the severity of atherosclerosis and worse outcome of percutaneous interventions. Thus, we aimed to interrogate the relationship between CHADS2 score and ISR in patients with stent implantation for AIOD.

Methods: This was a retrospective, observational study that included 419 consecutive patients who had successful common iliac artery (CIA) and external iliac artery stent implantation. Post-procedural ISR is evaluated by either ultrasonography or angiography for each patient in the follow-up period. Patients were then divided into two groups ISR (+) and ISR (–). CHADS2 score was calculated for every patient.

Results: ISR was detected in 47 out of 419 patients. Patients who had ISR had smaller stent diameter (8.4±0.9 vs. 7.2±2.8, p=0.005) and longer stent length (80 [59–120] mm vs. 59 [39–100] mm, p<0.001) than those without ISR. CHADS2 score was significantly found increased in patients with ISR than those without ISR (2.04 ± 0.98 vs. 1.45±0.93, p<0.001). Chronic obstructive pulmonary disease (COPD) (hazard ratios [HR]: 2.85, 95% confidence interval [CI]: 1.535–5.293, p=0.001), CHADS2 score (HR: 1.571, 95% CI: 1.186–2.081, p=0.002), and decreased stent diameter (HR: 0.582, 95% CI: 0.366–0.926, p=0.022) were found to be independently associated with ISR.

Conclusion: Our study demonstrated that COPD, CHADS2 score, and stent diameter were associated with ISR for patients who had successful iliac artery stent implantation. According to our study, this simple and applicable scoring system can be used to predict patients at high risk for ISR.

Cite This Article: Demirci G, Şahin AA, Altunova M, Aktemur T, Tekin M, Yıldız M, Ertürk M. The Relationship of CHADS2 Score with In-stent Restenosis in Patients Undergoing Iliac Artery Stenting. Koşuyolu Heart J 2024;27(1):9–15.

Ethics Committee Approval

The study was approved by the İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Clinical Research Ethics Committee (no: 2023.01-02, date: 10/01/2023).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept – G.D.; Design – G.D.; Supervision – G.D.; Funding – G.D.; Materials – M.A.; Data collection and/or processing – T.A., M.T.; Data analysis and/or interpretation – A.A.Ş., M.T.; Literature search – G.D., M.Y.; Writing – G.D., A.A.Ş.; Critical review – M.E., M.Y.

Conflict of Interest

All authors declared no conflict of interest.

Use for AI for Writing Assistance

Not declared.

Financial Disclosure

The authors declared that this study received no financial support.