Zhang Longhui, Zhu Haoyu, Zhang Yupeng, Chen Fangguang, Sun Dapeng, Liu Yufan, Jiang Chuhan, Miao Zhongrong, Jia Baixue
Interventional Neuroradiology Department, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Transl Stroke Res. 2025 Mar 22. doi: 10.1007/s12975-025-01346-0.
Little is known about the association between periprocedural hemodynamics and in-stent restenosis (ISR) following stent implantation in patients with symptomatic intracranial atherosclerotic stenosis (ICAS). This study aims to identify periprocedural hemodynamics that may be associated with ISR. Subjects were selected from the NOVA trial (The First-in-man Trial Evaluating the Safety and Efficacy of the NOVA Intracranial Stent Trial). ISR was defined as greater than 50% stenosis of the luminal diameter within or immediately adjacent to (within 5 mm) the implanted stent. Periprocedural hemodynamics, including cerebral blood flow, cerebral blood volume, mean transit time, and time to peak (TTP), were derived from the time-density curve generated from digital subtraction angiography using the fast Fourier transform algorithm. Of the 263 patients enrolled in the NOVA trial, 176 with symptomatic high-grade ICAS who underwent stent implantation were included in this study. Of these, 35 (19.9%) were diagnosed with ISR at the one-year follow-up. No significant differences in pre-procedure hemodynamics were observed between stent groups and between the ISR groups and the non-ISR group. Higher post-procedure TTP (OR, 1.95; 95% CI, 1.26-3.02), the use of bare-metal stents (OR, 5.40; 95% CI, 2.21-13.19), and higher post-procedure residual stenosis (OR, 1.08; 95% CI, 1.03-1.13) were independent factors associated with ISR. Higher post-procedure TTP, the use of bare-metal stents, and higher post-procedure residual stenosis were independent factors associated with ISR. The combined use of periprocedural hemodynamics and clinical factors may help predict ISR in patients with symptomatic high-grade ICAS.
对于有症状的颅内动脉粥样硬化性狭窄（ICAS）患者，在支架植入术后，围手术期血流动力学与支架内再狭窄（ISR）之间的关联鲜为人知。本研究旨在确定可能与ISR相关的围手术期血流动力学指标。研究对象选自NOVA试验（评估NOVA颅内支架安全性和有效性的首例人体试验）。ISR定义为植入支架内或紧邻支架（5mm内）的管腔直径狭窄超过50%。围手术期血流动力学指标，包括脑血流量、脑血容量、平均通过时间和达峰时间（TTP），通过使用快速傅里叶变换算法从数字减影血管造影生成的时间-密度曲线得出。在NOVA试验纳入的263例患者中，本研究纳入了176例接受支架植入的有症状的重度ICAS患者。其中，35例（19.9%）在一年随访时被诊断为ISR。在支架组之间以及ISR组与非ISR组之间，术前血流动力学指标未观察到显著差异。术后较高的TTP（比值比[OR]，1.95；95%置信区间[CI]，1.26 - 3.02）、使用裸金属支架（OR，5.40；95% CI，2.21 - 13.19）以及术后较高的残余狭窄（OR，1.08；95% CI，1.03 - 1.13）是与ISR相关的独立因素。术后较高的TTP、使用裸金属支架以及术后较高的残余狭窄是与ISR相关的独立因素。围手术期血流动力学指标与临床因素的联合应用可能有助于预测有症状的重度ICAS患者的ISR。
