Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis

Abstract

Objective: In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation. Methods: Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6–8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland–Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation. Results: Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6–8 months showed that the degree of stenosis was 40% (range, 30–72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30–75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland–Altman plot showed that all data points were within the consistency limits ([Formula: see text] ± 1.96 s). Conclusion: As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR. Advances in knowledge: This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.

Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

“…In-stent restenosis may occur, with the rate of restenosis ranging 2.38% to 26.7% at follow-up months after stenting. [11,13–18] In our study, the in-stent restenosis rate was 12.54% at a follow-up duration of 28 ± 6.7 months, with the symptomatic restenosis in 8 (22.22%) patients and non-symptomatic restenosis in other 28 (77.78%). Twenty-eight patients with restenosis did not have any symptoms probably because the restenosis was slowly built up and enabled sufficient collateral circulation to set up.…”

“…[9,10] Moreover, in-stent restenosis may occur after percutaneous transluminal angioplasty and stenting in patients with intracranial atherosclerotic stenosis, and postoperative in-stent restenosis has been reported to range 2.38% to 26.7% at follow-up months after stenting. [5,[11][12][13][14][15][16][17][18] Even though the SAMMPRIS study denied the association of high perioperative complications with the surgeons technical experience in stenting, [9,10] a previous study enrolling 433 patients [19] has revealed a significantly (P < .05) higher complication rate during the initial experience accumulation stage than the later technical maturation stage. Further analysis demonstrated that the incidences of hemorrhagic, thrombotic and fatal/disabling complications were closely associated with the surgeons experience levels and that the complication rates pertinent to surgical techniques exhibited an apparent learning curve, which was consistent with other studies.…”

High-resolution vessel wall imaging for quantitatively and qualitatively evaluating in-stent stenosis of intracranial aneurysms

“…Therefore, the unenhanced HR-VWI might be preferable to assess ISS alone in clinical practice since it avoids the potential side effects of gadolinium toxicity and nephrogenic systemic fibrosis ( 27 , 28 ). However, CE-HR-VWI might be needed if further exploration of the cause of ISS is required, such as additional information on the enhancement of stented parent arteries wall or lumen ( 18 ).…”

“…In the four MR imaging modalities and DSA images, the method used for determining the percentage of stenosis of a stented parent artery (immediately adjacent to or within 5 mm of the stent) was the same as that used in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study: percentage of stenosis = (1 − [D stenosis /D normal ]) × 100, where D stenosis is the diameter of the stented parent artery at the site of the most severe stenosis and D normal is the diameter of the proximal lumen of the normal stented parent artery adjacent to the stenosis ( 17 , 18 ). When there was no change in the parent artery diameter, cases were graded as no stenosis ( 4 ); otherwise, cases were graded as intimal hyperplasia (1–24%), mild (25–49%), moderate (50–74%), or severe (≥75%) ( 19 ).…”