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Influence of Residual Stenosis on Clinical Outcome and Restenosis After Middle Cerebral Artery Stenting

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Abstract

Background

The purpose of this study was to assess whether the residual stenosis has effect on restenosis after stenting for atherosclerotic stenosis in the middle cerebral artery.

Methods

Sixty-seven patients underwent 69 single-stent procedures successfully for atherosclerotic stenosis ≥70% in the M1 segment of middle cerebral artery were reviewed retrospectively. All patients were classified into two groups: nonresidual (≤30%) and residual (>30%) stenosis. The influence of residual stenosis immediately after stent placement on clinical outcomes and restenosis at follow-up was analyzed. Restenosis was defined as ≥20% stenosis on angiographic follow-up imaging after excluding postoperative residual stenosis.

Results

Between groups, it was no difference in the conventional risk factors of cerebrovascular diseases, characteristics of targeted vessels, and types of stent. The residual stenosis had no influence on any stroke or death, but the ipsilateral stroke had a trend in the residual stenosis group. The incidence of restenosis was higher in patients with residual stenosis >30% (17% vs. 45.5%, P = 0.04), and the increase of percent stenosis was 7.9 ± 11.7 and 17.1 ± 15.4, respectively (P = 0.03). The correlation coefficient was r = 0.37 (P < 0.01) between the residual stenosis and the increase of percent stenosis. Univariate and multivariate regression analysis showed that residual stenosis >30% was an independent risk factor for restenosis at follow-up (log-rank, Chi-square = 6.09, P = 0.01).

Conclusions

Residual stenosis immediately after stenting for atherosclerotic middle cerebral artery stenosis may be a predictor of clinical outcomes and restenosis at follow-up.

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References

  1. Wong KS, Huang YN, Gao S, Lam WW, Chan YL, Kay R (1998) Intracranial stenosis in Chinese patients with acute stroke. Neurology 50(3):812–813

    PubMed  CAS  Google Scholar 

  2. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, Levine SR, Chaturvedi S, Kasner SE, Benesch CG et al (2005) Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352(13):1305–1316

    Article  PubMed  CAS  Google Scholar 

  3. Arenillas JF, Molina CA, Montaner J, Abilleira S, Gonzalez-Sanchez MA, Alvarez-Sabin J (2001) Progression and clinical recurrence of symptomatic middle cerebral artery stenosis: a long-term follow-up transcranial Doppler ultrasound study. Stroke 32(12):2898–2904

    Article  PubMed  CAS  Google Scholar 

  4. Sundt TM Jr, Smith HC, Campbell JK, Vlietstra RE, Cucchiara RF, Stanson AW (1980) Transluminal angioplasty for basilar artery stenosis. Mayo Clin Proc 55(11):673–680

    PubMed  Google Scholar 

  5. Lee TH, Kim DH, Lee BH, Kim HJ, Choi CH, Park KP, Jung DS, Kim S, Moon TY (2005) Preliminary results of endovascular stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. AJNR Am J Neuroradiol 26(1):166–174

    PubMed  Google Scholar 

  6. Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, Berlis A, Reul J, Yu SC, Forsting M et al (2007) A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke 38(5):1531–1537

    Article  PubMed  CAS  Google Scholar 

  7. Connors JJ III, Wojak JC (1999) Percutaneous transluminal angioplasty for intracranial atherosclerotic lesions: evolution of technique and short-term results. J Neurosurg 91(3):415–423

    Article  PubMed  Google Scholar 

  8. Kim JK, Ahn JY, Lee BH, Chung YS, Chung SS, Kim OJ, Kim WC, Joo JY (2004) Elective stenting for symptomatic middle cerebral artery stenosis presenting as transient ischaemic deficits or stroke attacks: short term arteriographical and clinical outcome. J Neurol Neurosurg Psychiatry 75(6):847–851

    Article  PubMed  CAS  Google Scholar 

  9. SSYLVIA Study Investigators (2004) Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke 35(6):1388–1392

    Article  Google Scholar 

  10. Zaidat OO, Klucznik R, Alexander MJ, Chaloupka J, Lutsep H, Barnwell S, Mawad M, Lane B, Lynn MJ, Chimowitz M (2008) The NIH registry on use of the Wingspan stent for symptomatic 70–99% intracranial arterial stenosis. Neurology 70(17):1518–1524

    Article  PubMed  CAS  Google Scholar 

  11. Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, Purdy PD, Welch BG, Woo HH, Rasmussen PA et al (2008) Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery 63(1):23–27 discussion 27-28

    Article  PubMed  Google Scholar 

  12. Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch BG, Niemann DB, Purdy PD, Aagaard-Kienitz B, Rasmussen PA et al (2008) Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol 29(1):23–27

    Article  PubMed  CAS  Google Scholar 

  13. Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, Purdy P, Welch B, Woo H, Rasmussen PA et al (2007) Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery 61(3):644–650 discussion 650–651

    Article  PubMed  Google Scholar 

  14. Sick P, Huttl T, Niebauer J, Thiele H, Lauer B, Hambrecht R, Hentschel B, Schuler G (2003) Influence of residual stenosis after percutaneous coronary intervention with stent implantation on development of restenosis and stent thrombosis. Am J Cardiol 91(2):148–153

    Article  PubMed  Google Scholar 

  15. Yue X, Yin Q, Xi G, Zhu W, Xu G, Zhang R, Zhou Z, Ma M, Jin G, Liu X (2010) Comparison of BMSs with SES for Symptomatic Intracranial Disease of the Middle Cerebral Artery Stenosis. Cardiovasc Intervent Radiol. Epub ahead of print

  16. Jiang WJ, Xu XT, Jin M, Du B, Dong KH, Dai JP (2007) Apollo stent for symptomatic atherosclerotic intracranial stenosis: study results. AJNR Am J Neuroradiol 28(5):830–834

    PubMed  Google Scholar 

  17. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21(4):643–646

    PubMed  CAS  Google Scholar 

  18. Singh M, Gersh BJ, McClelland RL, Ho KK, Willerson JT, Penny WF, Holmes DR Jr (2004) Clinical and angiographic predictors of restenosis after percutaneous coronary intervention: insights from the Prevention of Restenosis With Tranilast and Its Outcomes (PRESTO) trial. Circulation 109(22):2727–2731

    Article  PubMed  Google Scholar 

  19. Presbitero P, Carcagni A (2003) Gender differences in the outcome of interventional cardiac procedures. Ital Heart J 4(8):522–527

    PubMed  Google Scholar 

  20. Groschel K, Schnaudigel S, Pilgram SM, Wasser K, Kastrup A (2009) A systematic review on outcome after stenting for intracranial atherosclerosis. Stroke 40(5):e340–e347

    Article  PubMed  Google Scholar 

  21. Fiorella D, Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Hanel RA, Woo H, Rasmussen PA, Hopkins LN et al (2007) U.S. multicenter experience with the wingspan stent system for the treatment of intracranial atheromatous disease: periprocedural results. Stroke 38(3):881–887

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors have no personal financial or institutional interest and no conflicts to disclose.

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Authors and Affiliations

  1. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu, China

    Xuanye Yue, Tingting Lu, Gelin Xu, Wenhua Liu, Renliang Zhang, Qin Yin & Xinfeng Liu

  2. Department of Neurology, Shiyan People Hospital, Yunyang Medical College, Shiyan, Hubei, China

    Xuanye Yue & Gangming Xi

Authors
  1. Xuanye Yue
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  2. Gangming Xi
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  3. Tingting Lu
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  4. Gelin Xu
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  5. Wenhua Liu
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  6. Renliang Zhang
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  7. Qin Yin
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  8. Xinfeng Liu
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Corresponding author

Correspondence to Xinfeng Liu.

Additional information

Xuanye Yue and Gangming Xi contributed equally to this works.

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Yue, X., Xi, G., Lu, T. et al. Influence of Residual Stenosis on Clinical Outcome and Restenosis After Middle Cerebral Artery Stenting. Cardiovasc Intervent Radiol 34, 744–750 (2011). https://doi.org/10.1007/s00270-010-9989-5

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  • DOI: https://doi.org/10.1007/s00270-010-9989-5

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