[Predictive value of the Mori classification for restenosis after drug-coated balloon angioplasty in symptomatic intracranial atherosclerotic stenosis].

Objectives: To evaluate the mid- to long-term efficacy of drug-coated balloon (DCB) angioplasty for symptomatic intracranial atherosclerotic stenosis (sICAS), and to assess the predictive value of the Mori classification for post-procedural restenosis. Methods: This retrospective case series study enrolled 56 patients with sICAS who underwent DCB angioplasty at Beijing Hospital between September 2018 and September 2024. The age was (62.2±10.2) years (range: 44 to 83 years), 36 patients (64.3%) were male and 20 patients (35.7%) were female. Patients were divided into a restenosis group and a non-restenosis group according to the presence of imaging restenosis after the procedure. Imaging restenosis was defined as recurrent stenosis ≥50% of the target vessel diameter compared with the immediate post-procedural result. Between-group comparisons were performed using the independent-samples t test, Mann-Whitney U test, χ2 test, or Fisher's exact test. Multivariate binary logistic regression was used to identify independent factors associated with restenosis. A nomogram-based prediction model was constructed and internally validated by 1 000 bootstrap resamples, and decision curve analysis (DCA) was used to assess clinical net benefit. Results: Among the 56 patients, the residual stenosis after DCB angioplasty (M(IQR)) was 20.0 (30.0)%(range:0 to 50%), and 5 patients (8.9%) received bailout stenting. During the follow-up of 23.0(17.0) months (range: 12 to 82 months), imaging restenosis occurred in 9 patients (16.1%) and symptomatic restenosis in 1 patient (1.8%). The restenosis rates for Mori type A, B, and C lesions were 1/16, 12.1% (4/33), and 4/7, respectively. Univariate and multivariate analyses identified the Mori classification as an independent predictor of restenosis(OR=11.73, 95%CI: 2.02 to 68.18, P=0.006). DCA indicated that the model provided a high clinical net benefit within the threshold probability range of 0 to 0.55. Conclusions: DCB angioplasty for sICAS demonstrated stable mid- to long-term efficacy and a favorable safety profile. The Mori classification is an independent risk factor for restenosis and may aid preoperative risk stratification and individualized management.