Protective Factors of Postendovascular Therapy Restenosis for Symptomatic Intracranial Arterial Stenosis: A Retrospective Analysis

BACKGROUND AND PURPOSE: Symptomatic intracranial arterial stenosis (ICAS) markedly increases the risk of recurrent ischemic stroke, with high restenosis rates after endovascular therapy. This study aims to identify factors influencing restenosis within 1 year after endovascular therapy for ICAS, with the goal of reducing restenosis rates through interventions targeting protective and risk factors.

MATERIALS AND METHODS: We conducted a retrospective analysis of symptomatic patients with ICAS who underwent endovascular therapy between January 2016 and June 2023 at our hospital. Patients were divided into restenosis and nonrestenosis groups based on the occurrence of restenosis within 1 year after endovascular therapy. Data on clinical characteristics, type of endovascular therapy, postendovascular antiplatelet therapy, statin therapy, and risk factor management were collected and analyzed. Comparisons were made between groups regarding baseline characteristics, type of endovascular therapy (balloon angioplasty alone versus stent placement), and secondary prevention measures (dual antiplatelet therapy, optimal blood pressure, glucose, and lipid control, no current smoking). Binary logistic regression was used to determine independent protective and risk factors for restenosis.

RESULTS: The study included 154 participants, with 45 in the restenosis group (mean age 61.1 ± 9.8 years) and 109 in the nonrestenosis group (mean age 58.5 ± 11.3 years). There were no statistically differences in baseline characteristics between groups; however, the restenosis group had a lower proportion of stent placement than balloon angioplasty (42.2% versus 61.5%; P = .03). Notable reductions were observed in the restenosis group in optimal glucose control (51.1% versus 77.1%; P = .002), optimal lipid control (42.2% versus 67.9%; P = .004), and no current smoking (60.0% versus 83.5%; P = .002). Logistic regression revealed that stent placement (OR, 0.380, 95% CI, 0.172–0.840, P = .02), optimal glucose (OR, 0.320, 95% CI, 0.142–0.723, P = .006) and lipid control (OR, 0.405, 95% CI, 0.185–0.887, P = .02), and no current smoking (OR, 0.234, 95% CI, 0.096–0.569, P = .001) were protective factors against postendovascular restenosis.

CONCLUSIONS: Stent placement, optimal glucose and lipid control, and no current smoking independently protect against postendovascular restenosis in patients with symptomatic ICAS. Effective management of these risk factors is crucial in clinical practice to minimize the incidence of postendovascular restenosis.