Wang Ning, Lu Yuning, Feng Lei, Lin Dongdong, Gao Yuhai, Wu Jiong, Wang Ming, Wan Shu
Brain Center, Zhejiang Hospital, Hangzhou, China.
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Front Neurol. 2023 Jul 14;14:1170110. doi: 10.3389/fneur.2023.1170110. eCollection 2023.
In-stent restenosis (ISR) is an adverse and notable event in the treatment of intracranial atherosclerotic stenosis (ICAS) with percutaneous transluminal angioplasty and stenting (PTAS). The incidence and contributing factors have not been fully defined. This study was performed to evaluate factors associated with ISR after PTAS.
We identified studies on ISR after PTAS from an electronic search of articles in PubMed, Ovid MEDLINE, and the Cochrane Central Database (dated up to July 2022).
A total of 19 studies, including 452 cases of ISR after 2,047 PTAS, were included in the meta-analysis. The pooled incidence rate of in-stent restenosis was 22.08%. ISR was more likely to occur in patients with coronary artery disease (OR = 1.686; 95% CI: 1.242-2.288; = 0.0008), dissection (OR = 6.293; 95% CI: 3.883-10.197; < 0.0001), and higher residual stenosis (WMD = 3.227; 95% CI: 0.142-6.311; = 0.0404). Patients treated with Wingspan stents had a significantly higher ISR rate than those treated with Enterprise stents (29.78% vs. 14.83%; < 0.0001).
The present study provides the current estimates of the robust effects of some risk factors for in-stent restenosis in intracranial atherosclerotic stenosis. The Enterprise stent had advantages compared with the Wingspan stent for ISR. The significant risk factors for ISR were coronary artery disease, dissection, and high residual stenosis. Local anesthesia was a suspected factor associated with ISR.
支架内再狭窄（ISR）是经皮腔内血管成形术和支架置入术（PTAS）治疗颅内动脉粥样硬化狭窄（ICAS）过程中的一种不良且显著的事件。其发生率和相关因素尚未完全明确。本研究旨在评估PTAS术后与ISR相关的因素。
我们通过对PubMed、Ovid MEDLINE和Cochrane中央数据库（截至2022年7月）中的文章进行电子检索，确定了关于PTAS术后ISR的研究。
荟萃分析共纳入19项研究，包括2047例PTAS术后的452例ISR病例。支架内再狭窄的合并发生率为22.08%。ISR更易发生于患有冠状动脉疾病的患者（OR = 1.686；95% CI：1.242 - 2.288；P = 0.0008）、血管夹层患者（OR = 6.293；95% CI：3.883 - 10.197；P < 0.0001）以及残余狭窄较高的患者（WMD = 3.227；95% CI：0.142 - 6.311；P = 0.0404）。使用Wingspan支架治疗的患者ISR发生率显著高于使用Enterprise支架治疗的患者（29.78%对14.83%；P < 0.0001）。
本研究提供了当前对颅内动脉粥样硬化狭窄支架内再狭窄一些危险因素的有力影响的估计。在预防ISR方面，Enterprise支架比Wingspan支架具有优势。ISR的显著危险因素是冠状动脉疾病、血管夹层和高残余狭窄。局部麻醉是一个与ISR相关的可疑因素。
