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Ischemic stroke
Original research
Association of residual stenosis after balloon angioplasty with vessel wall geometries in intracranial atherosclerosis
  1. Zhikai Hou1,2,
  2. Zhe Zhang2,3,
  3. Long Yan1,2,
  4. Jidong You1,2,
  5. Min Wan1,2,
  6. Jia Song1,2,
  7. Yuesong Pan2,
  8. Ferdinand Hui4,
  9. Zhongrong Miao1,2,
  10. Xin Lou5,
  11. Yongjun Wang2,6,
  12. Jing Jing2,3,6,
  13. Ning Ma1,2
  1. 1 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2 China National Clinical Research Center for Neurological Diseases, Beijing, China
  3. 3 Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  4. 4 Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
  5. 5 Department of Radiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
  6. 6 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Ning Ma, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China; maning_03{at}hotmail.com; Dr Jing Jing, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.; jingj_bjttyy{at}163.com

Abstract

Background Percutaneous transluminal balloon angioplasty (PTBA) may be an alternative treatment for patients with symptomatic intracranial atherosclerotic disease (ICAD) refractory to medical treatment. This study aimed to investigate the association of vessel wall geometric characteristics on high-resolution magnetic resonance vessel wall imaging (MR-VWI) with low residual stenosis in patients with ICAD after PTBA.

Methods Patients with symptomatic ICAD who underwent PTBA were prospectively and consecutively enrolled. High-resolution MR-VWI was performed before the PTBA. Vessel wall geometries of the target artery, including normalized wall index (NWI: wall area/vessel area × 100%), normalized wall thickness index (NWTI: mean wall thickness/vessel radius × 100%), and remodeling index (RI) were evaluated. Low residual stenosis was defined as postprocedural stenosis degree ≤50%. Perioperative complications including symptomatic ischemic stroke/intracranial hemorrhage, death, and arterial dissection were recorded. The baseline characteristics, vessel wall geometries, and perioperative complications were compared between the patients with low residual stenosis and high residual stenosis.

Results Among 60 patients prospectively enrolled, low residual stenosis was achieved in 46 participants (77%). Three patients (5%) suffered from symptomatic ischemic stroke within 30 days. Multivariable logistic regression showed that a lower NWI and lower NWTI were associated with low residual stenosis after PTBA (adjusted OR 0.57, 95% CI 0.35 to 0.94, p=0.027; and adjusted OR 0.88, 95% CI 0.80 to 0.98, p=0.015).

Conclusions Lower NWI and NWTI of the target artery on high-resolution MR-VWI were associated with low residual stenosis in patients with ICAD after PTBA.

  • angioplasty
  • vessel wall
  • stroke
  • plaque

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017997

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • ZH and ZZ contributed equally.

    • Contributors ZKH, ZZ, JJ, NM: study concept and design, data analysis, drafting the manuscript, and full responsibility of data. LY, JDY, MW, JS: data collection. ZKH, JJ, XL: imaging data analysis. YSP: data analysis. FH: revising the manuscript. ZRM, XL, YJW: study concept and design of the work. All authors approved the final version to be published. They agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

    • Funding This study was supported by the National Natural Science Foundation of China (Contract grant number: 81471390 to NM, 81825012 and 81730048 to XL). Specialized in clinical medical development - 'Yangfan Plan' (XMLX201844 to NM).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.