Serum High-Density Lipoprotein Levels and Risk of In-Stent Restenosis Following Carotid Artery Stenting: A Multivariate Analysis-Based Retrospective Cohort Study

Objective: To investigate the relationship between serum high-density lipoprotein (HDL) levels and the risk of in-stent restenosis (ISR) following carotid artery stenting (CAS), aiming to provide potential targets for ISR prevention and treatment. Methods: A retrospective analysis was conducted on 132 patients who underwent CAS in the Department of Neurosurgery at Wenzhou Central Hospital between March 2019 and January 2024 and had 6-month (±1 month) follow-up data available. Patients were divided into ISR group (96 cases) and non-ISR group (36 cases) based on the occurrence of ISR. Demographic, clinical, and laboratory data were collected for both groups. Independent predictors of ISR were identified using t-test, Mann-Whitney U test, chi-square test, and logistic regression analysis. The predictive performance of the model was evaluated using ROC curve analysis. Results: Serum HDL levels were significantly lower in the ISR group than in the non-ISR group (p < 0.001). Univariate logistic regression analysis showed that male gender, smoking, hypertension, high BMI, and elevated serum globulin levels were positively associated with ISR risk (p < 0.05), while higher serum HDL levels were negatively associated with ISR risk (p < 0.05). Multivariate logistic regression analysis further confirmed that smoking, hypertension, and elevated serum globulin levels were independent risk factors for ISR (p < 0.05), while higher serum HDL levels were an independent protective factor for ISR (p < 0.05). ROC curve analysis indicated that the multivariable model had good predictive performance for ISR, with an AUC of 0.84. At the optimal cutoff point, the model demonstrated a sensitivity of 92% and a specificity of 75%. Conclusion: Serum high-density lipoprotein (HDL) plays a crucial protective role in the development of ISR. Monitoring and increasing serum HDL levels may help prevent ISR and improve patient prognosis.