Outcome of endovascular recanalization for intracranial in-stent restenosis

Abstract

Background and purposeIn-stent restenosis (ISR) is one of the long-term adverse outcomes of endovascular angioplasty and stenting for symptomatic intracranial arterial stenosis. In this study, we try to evaluate the safety and efficacy of endovascular treatment for intracranial ISR.MethodsWe retrospectively collected patients with intracranial ISR who underwent endovascular treatment from June 2012 to August 2019 at a high-volume stroke center. Successful recanalization was defined as ≤30% residual stenosis. Stroke, myocardial infarction, and death after stenting within 30 days were used to evaluate periprocedural safety. Recurrent stroke in the territory of the culprit vessel and re-ISR in patients with clinical and vascular imaging follow-up data were used to evaluate the long-term outcome.Results32 patients (59.6±7.2 years old) with ISR were recruited, including 22 patients (68.8%) treated with balloon dilatation, 8 patients (25%) with stenting, and 2 patients (6.3%) with failed procedures. Successful recanalization was achieved in 71.9% (23/32) of patients. There was no stroke, myocardial infarction or death within 30 days after the procedure. Recurrent stroke was found in 10.7% (3/28) of the patients, and re-ISR was found in 42.1% (8/19) of the patients. The re-ISR rate was lower in patients with stenting than in those with balloon dilatation (0% vs 57.1%, p=0.090), and in patients with successful recanalization than in those with unsuccessful recanalization (33.3% vs 75.0%, p=0.352), but with no statistically significant difference.ConclusionsThe periprocedural safety of endovascular treatment for intracranial ISR may be acceptable, but the long-term rates of recurrent stroke and re-ISR remain at high levels.

Intracranial Angioplasty with Enterprise Stent for Intracranial Atherosclerotic Stenosis: A Single-Center Experience and a Systematic Review

“…These results indicated that the long-term stroke prevention of the Enterprise stent was relatively good. Long-term complications are often associated with ISR, and the high incidence of ISR after stent implantation for ICAS has long been a major disadvantage of placing stents [38]. ISR is common in the first year after PTAS and an important cause of nonsurgical ischemic events after stent placement [10].…”

“…Several relevant studies have indicated that ISR may be related to lesion location, preoperative stenosis, use of a balloon, and the application of antiplatelet drugs [38]. However, few studies have focused on the mechanisms underlying ISR.…”

“…BioMed Research International bypass surgery, and endovascular recanalization, but most of these treatments have unsatisfactory outcomes [38]. In our center, the use of antiplatelet agents was strictly regulated based on the WASID trial to better prevent the emergence of ISR.…”

Collateral circulation is a predictor for in-stent restenosis after cerebral anterior circulation large artery stenting

“…These patients were satis ed with the inclusion criteria as follows: (1) cerebral anterior circulation atherosclerosis stenosis ( cervical segment to communicating segment of the internal carotid artery, middle cerebral artery M1 segment) and recurrent ischemic stroke even with standard secondary prevention, however, all patients were in the non-acute stage; (2) DSA indicated severe stenosis (≥ 70%); (3) willing to be follow-up, including carotid artery ultrasound or Transcranial Doppler; (4) mRS ≤ 2 before stenting. The exclusion criteria as follows: (1) severe cerebral anterior circulation large artery stenosis caused by nonatherosclerotic, such as cardiogenic stroke, arterial dissection, vasculitis, bromuscular dystrophy, and moyamoya disease; (2) history of cerebrovascular interventional treatment; (3) cerebral posterior circulation large artery stenting; (4) complicated with a tumor, autoimmune disease, liver or kidney dysfunction, and other serious diseases; (5) other intracranial diseases; (6) in a state of acute or chronic infection; (7) death after stenting. This retrospective study was performed and approved by the Institutional Ethics Committee of the Second Hospital of Hebei Medical University (Grant Number: 2020-R384).…”

“…About 22%-46% of ischemic stroke were caused by severe cerebral large artery atherosclerotic stenosis 1,2 . Even though received normative medication, a high risk of progression and recurrence might have happened in such patients.…”