RESUMEN
Background: In-stent restenosis is a crucial problem after carotid artery stenting, but the exact predictors of in-stent restenosis remain unclear. We aimed to evaluate the effect of cerebral collateral circulation on in-stent restenosis after carotid artery stenting and to establish a clinical prediction model for in-stent restenosis. Methods: This retrospective case-control study enrolled 296 patients with severe carotid artery stenosis of C1 segment (≥70%) who underwent stent therapy from June 2015 to December 2018. Based on follow-up data, the patients were divided into the in-stent restenosis and no in-stent restenosis groups. The collateral circulation of the brain was graded according to the criteria of the American Society for Interventional and Therapy Neuroradiology/Society for Interventional Radiology (ASITN/SIR). Clinical data were collected, such as age, sex, traditional vascular risk factors, blood cell count, high-sensitivity C-reactive protein, uric acid, stenosis degree before stenting and residual stenosis rate, and medication after stenting. Binary logistic regression analysis was performed to identify potential predictors of in-stent restenosis, and a clinical prediction model for in-stent restenosis after carotid artery stenting was established. Results: Binary logistic regression analysis showed that poor collateral circulation was an independent predictor of in-stent restenosis (P=0.003). We also found that a 1% increase in residual stenosis rate was associated with a 9% increase in the risk of in-stent restenosis (P=0.02). Ischemic stroke history (P=0.03), family history of ischemic stroke (P<0.001), in-stent restenosis history (P<0.001), and nonstandard medication after stenting (P=0.04) were predictors of in-stent restenosis. The risk of in-stent restenosis was lowest when the residual stenosis rate was 12.5% after carotid artery stenting. Furthermore, we used some significant parameters to construct a binary logistic regression prediction model for in-stent restenosis after carotid artery stenting in the form of a nomogram. Conclusions: Collateral circulation is an independent predictor of in-stent restenosis after successful carotid artery stenting, and the residual stenosis rate tends to be below 12.5% to reduce restenosis risk. The standard medication should be strictly carried out for patients after stenting to prevent in-stent restenosis.
RESUMEN
This study identifies predictors of favourable intracranial venous collaterals and the effect of intracranial venous collaterals on outcomes and recanalization in patients with cerebral venous thrombosis (CVT). Data of 61 patients with CVT were retrospectively reviewed. Venous collateralization was defined as expanded cortical vein formation through different drainage pathways. Recanalization grades were classified into complete or partial recanalization based on images obtained during hospitalisation and follow-up. Independent predictors of collateral formation and poor prognosis were investigated via univariate and binary logistic regression analyses. The effects of different intracranial venous collaterals on recanalization in patients with CVT were assessed. A risk prediction nomogram for prognosis was constructed. Age ≤ 35 years (odds ratio (OR) = 7.067; 95% confidence interval (CI) = 1.776-28.277; P = 0.006) and male sex (OR = 5.490; 95% CI = 1.205-25.004; P = 0.028) were independent predictors of favourable venous collaterals. Venous collaterals were associated with early recanalization (P = 0.017) and not with long-term recanalization (P = 0.252). Male sex (OR = 0.047; 95% CI = 0.003-0.651; P = 0.023), subacute onset (OR = 0.026; 95% CI = 0.002-0.367; P = 0.007), and good collateral grade (OR = 0.168; 95% CI = 0.029-0.985; P = 0.048) were independent factors of favourable neurological outcomes at discharge. Haemorrhage on computed tomography at admission (OR = 10.868; 95% CI = 2.082-56.733; P = 0.005) was inversely correlated with prognosis. These findings suggested that male patients under 35 years of age are more likely to have favourable venous collaterals and good outcomes. Venous collaterals are significantly associated with early recanalization. These findings highlight the importance of venous collateral evaluation in patients with CVT.