Post-procedural hemodynamics by quantitative DSA predict restenosis in chronic internal carotid artery occlusion.

OBJECTIVE: Hemodynamic status concerning restenosis of chronic internal carotid artery occlusion (CICAO) after successful endovascular recanalization are scarce. This study is aim to identify post-procedural hemodynamics that may be associated with restenosis. METHOD: This study retrospectively enrolled 202 patients who successfully underwent endovascular recanalization for CICAO. Quantitative digital subtraction angiography (QDSA) was employed to assess immediate post-procedural hemodynamic parameters of the internal carotid artery. A hierarchical modeling strategy was implemented to construct predictive models and determine the incremental predictive value of hemodynamic parameters. Internal validation of the models was performed using bootstrap resampling with 1000 repetitions. RESULTS: 48 patients (23.8%) developed restenosis during a mean follow-up of 45.3 months. The integrated model identified five independent predictors: residual stenosis (OR 2.54, 95% CI 0.97–6.60), hypertension (OR 2.96, 95% CI 1.38–6.65), blood glucose (OR 1.21, 95% CI 1.02–1.43), prolonged time-to-peak (TTP) (OR 1.51, 95% CI 1.17–2.03), and reduced cerebral blood flow (CBF) (OR 0.95, 95% CI 0.93–0.98). The model demonstrated superior discriminative ability (AUC 0.803 vs. 0.697, p = 0.004) and good calibration (Brier score 0.140). CONCLUSION: Hemodynamic assessment, particularly TTP and CBF measurements, significantly enhances the predictive performance of restenosis in CICAO patients after endovascular recanalization. The validated integrated model provides an effective tool for individualized risk stratification and postoperative management.