Increased Serum CRP-Albumin Ratio is Independently Associated With In-Stent Restenosis After Carotid Artery Stenting

Atherosclerotic stenosis of the carotid artery contributes significantly to ischemic strokes. This study investigates the correlation between the C-reactive protein (CRP) to albumin ratio (CAR) and in-stent restenosis (ISR) in patients (<i>n</i> = 529) undergoing carotid artery stenting. Patients were categorized based on ISR occurrence. Cox regression analyses were performed to identify independent predictors of ISR. The ISR rate was 10.3%. Laboratory analysis revealed higher levels of uric acid, CRP, and CAR in the ISR group. Cox regression identified CAR as an independent predictor of ISR (Hazard ratio (HR): 1.13, 95% CI: 1.03-1.24, <i>P</i> = .01), along with diabetes and smoking. A CAR cut-off of 0.28 predicted ISR with 93% sensitivity and 89% specificity (Area under the curve (AUC): 0.945, 95% CI: 0.923-0.963, <i>P</i> < .001). This study establishes a significant association between CAR and ISR in carotid artery stenting patients. The inflammatory response, indicated by CAR, emerges as a crucial factor in ISR development. The study contributes valuable insights into predicting and preventing ISR, emphasizing the potential of CAR as a prognostic biomarker. This easily accessible and cost-effective biomarker could enhance ISR prediction and guide preventive strategies for high-risk patients.