Effect of Angiographic Hemodynamic Parameters and Vascular Tortuosity on In-Stent Restenosis in Intracranial Atherosclerosis.

BACKGROUND AND

OBJECTIVE

In-stent restenosis (ISR) is an important factor affecting the long-term efficacy of stenting for intracranial atherosclerotic stenosis (ICAS). We aimed to investigate the risk factors of ISR by analyzing the clinical features, angiography-based hemodynamic parameters, and vascular morphology.

METHODS

Patients with severe symptomatic ICAS undergoing stenting were retrospectively screened. The vascular morphology was described by angle, relative length (RL), triangulation index (TI). Hemodynamic parameters were assessed by quantitative digital subtraction angiography. Four regions of interest (ROIs) were delineated near the lesion. Relative time to peak (rTTP) was the difference in TTP between ROIs. Logistic regression was performed to explore the risk factors of ISR.

RESULTS

Of the 312 patients, 106 (median [IQR] age, 61.0 [53.8-66.3] years; 83 [78.3%] male) were ultimately included, of whom 22 patients (20.8%) developed ISR, with a median follow-up time of 6.6 (6.1-8.8) months. Multivariate logistic analysis showed that residual stenosis (adjusted OR = 1.107, p = 0.007), monocyte to high-density lipoprotein cholesterol ratio (MHR) (adjusted OR = 1.031, p = 0.032), hyperglycemia (adjusted OR = 5.695, p = 0.015), post-stenting RL (adjusted OR = 0.802, p = 0.032) and trans-stenotic rTTP4 - 1 difference (adjusted OR = 6.995, p = 0.009) were significantly associated with ISR. The final predictive model for ISR presented strong predictive capabilities (AUC = 0.867, 95%CI 0.794-0.940).

CONCLUSIONS

Angiographic hemodynamic parameters, vascular tortuosity, and MHR are significant risk indicators associated with ISR. The developed model shows strong potential for identifying high-risk patients.