Impact of cerebral small vessel disease on symptomatic in-stent restenosis in intracranial atherosclerosis

Abstract

OBJECTIVE Cerebral small vessel disease (CSVD) commonly coexists with intracranial atherosclerotic stenosis (ICAS). In-stent restenosis (ISR) affects the nonprocedural outcome of severe symptomatic ICAS after intracranial stenting. However, only 8%–27% of ISR patients are symptomatic, which highlights the importance of the investigation of risk factors associated with symptomatic ISR (SISR) to improve long-term functional outcome. Whether CSVD is associated with SISR remains unclear. The authors tested the hypothesis that CSVD is associated with SISR in ICAS patients after intracranial stenting. METHODS This retrospective study enrolled 97 patients who were symptomatic due to severe anterior circulation ICAS treated with intracranial stenting. SISR was evaluated with clinical and vascular imaging follow-up. CSVD subtypes, including white matter hyperintensities (WMHs), enlarged perivascular spaces, and chronic lacunar infarctions, were evaluated. Cox regression analysis was used to compare the incidence of SISR between patients with and without CSVD. RESULTS Of the enrolled patients, 58.8% had CSVD. The 1- and 2-year ISR rates were 24.7% and 37.1%, respectively. Of the CSVD subtypes, SISR was associated with deep WMHs (DWMHs; HR 5.39, 95% CI 1.02–28.44). DWMH Fazekas scale grades 2 (HR 85.54, 95% CI 2.42–3018.93) and 3 (HR 66.24, 95% CI 1.87–2352.32) were associated with SISR, but DWMH Fazekas grades 0 and 1 were not. The proportions of SISR in patients with DWMH Fazekas grades 0, 1, 2, and 3 were 16.7%, 33.3%, 50%, and 100%, respectively. CONCLUSIONS Patients with CSVD have a higher risk of SISR than those without CSVD. Of the CSVD subtypes, patients with DWMHs are associated with SISR. The DWMH Fazekas scale score is considered to be a predictor for SISR.

The clinical significance of serum HMGB1 in patients with lower extremity arteriosclerosis obliterans after interventional vascular restenosis

“…There are many causes of restenosis after LEASO intervention, which are generally considered to be related to vascular inflammation, endothelial cell injury, and excessive proliferation and migration of smooth muscle cells ( 6 ). A large number of released inflammatory factors cause the body to show a high inflammatory state, which will aggravate the damage to vascular function and more easily lead to the occurrence of postoperative restenosis in patients.…”

Evaluation of paclitaxel-coated balloon angioplasty for the treatment of symptomatic intracranial in-stent restenosis

“…Despite the partial effectiveness of traditional methods like pharmacotherapy and bare-metal stent implantation in alleviating symptoms and improving prognosis, the high incidence of sISR remains a significant challenge ( 22 , 28 ). For instance, bare-metal stents, while temporarily expanding narrowed vessels, fail to effectively prevent neointimal hyperplasia, a leading cause of sISR ( 29 , 30 ).…”