Targeting ISR may improve prognosis after stenting

Kim Carollo | | Cardiovascular Business | Vascular & Endovascular

Intracranial in-stent restenosis (ISR), a common complication of percutaneous transluminal angioplasty and stenting (PTAS), may increase the likelihood of and an earlier incidence of recurrent ischemic events near the stented intracranial artery, according to a study published online Aug. 20 in Stroke.

“During the past decade, [PTAS] has been evolving as a possible treatment option for [intracranial in-stent restenosis] ICAS patients at a particularly high risk for recurrent stroke,” wrote the authors, led by Min Jin, MD, of the New Era Stroke Care and Research Institute in Beijing, China. “Numerous studies have discussed periprocedural complications of PTAS for ICAS. However, reliable data concerning prognosis of ISR patients are lacking so far.”

To prospectively study potential adverse outcomes, Jin and his colleagues followed 226 patients with symptomatic intracranial atherosclerosis who underwent stenting at New Era and later had catheter angiography.  There were a combined 233 lesions among the patients, with 57 placed in the ISR group and 176 in to the non-ISR group.

Their primary outcome measure was ischemic stroke or transient ischemia attack near the stented artery after the angiography. They defined ISR as a verified stenosis of 50 percent or greater within three millimeters of the stent.

After about three years of follow-up, 11.6 percent of the subjects met the endpoint criteria. The ISR group had a significantly higher risk of the ischemic events under investigation (21.1 percent vs. 8.5 percent). The outcomes also occurred earlier on average in the ISR group (9.9 months, compared with 26.6 months). They also found ISR to be an independent risk factor.

Although only a single-institute study with a relatively small number of lesions, the authors argued their research supports the need to manage ISR in this patient population.

“[R]educing the occurrence of ISR should be targeted in future research to improve the efficacy of intracranial PTAS,” they concluded.

 

Kim Carollo,

Contributor

Related Content

IVUS-guided PCI reduces risks in patients with diabetes
LAAC with Watchman FLX reduces bleeding risks after AFib ablation
Bioresorbable BTK stent superior to ballon angioplasty at 2 years
Shockwave Medical’s IVL technology delivers more positive outcomes for PAD patients
Standing desks fail to lower blood pressure or minimize heart risks—they may even do damage
IVL vs. RA for chronic total occlusion PCI: Key data cardiologists should know

Around the web

Health Imaging
Use of AI opportunistic screening in CT for cardiovascular disease

Ron Blankstein, MD, professor of radiology, Harvard Medical School, explains the use of artificial intelligence to detect heart disease in non-cardiac CT exams.

Health Imaging
New imaging protocols proposed to curb rise of cardiovascular infections

Eleven medical societies have signed on to a consensus statement aimed at standardizing imaging for suspected cardiovascular infections.

Radiology Business
What does radiology have to do with climate change?

Kate Hanneman, MD, explains why many vendors and hospitals want to lower radiology's impact on the environment. "Taking steps to reduce the carbon footprint in healthcare isn’t just an opportunity," she said. "It’s also a responsibility."