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Original research
Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting
  1. Jingzhi Li1,2,
  2. Yang Hua1,
  3. Laurence Needleman2,
  4. Flemming Forsberg2,
  5. John R Eisenbray2,
  6. Zhaojun Li3,
  7. Ran Liu1,
  8. Xiaojie Tian1,
  9. Liqun Jiao4,
  10. Ji-Bin Liu2
  1. 1Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  3. 3Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
  4. 4Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Professor Yang Hua, Department of Vascular Ultrasonography, Xuanwu Hospital, Beijing 100053, China; dryanghua99{at}


Objective The study was designed to investigate if vascular occlusion in the internal carotid artery (ICA) or the contralateral vertebral artery (VA) contribute to developing in-stent restenosis (ISR) in patients with vertebral artery ostium stenosis (VAOS).

Methods 420 consecutive patients treated with VAOS stents (from a population of 8145 patients with VAOS) from January 2013 to December 2014 were analyzed in this retrospective study; 216 with drug eluted stents and 204 with bare metal stents. Based on pre-stent DSA findings, patients were divided into four groups: both carotid and vertebral arteries patent (PAT), ICA occlusion (ICA-OCC), contralateral VA occlusion (CVA-OCC), and combined occlusions (C-OCC). The incidence of ISR (stenosis >50%) was compared between groups using Cox regression analysis.

Results Of the 420 patients, the mean incidence of ISR was 36.4%, with a median 12 months of follow-up (IQR 3–12). Logistic regression analysis showed that drug eluting stent had less ISR than bare metal stent (OR=0.38, 95% CI 0.19 to 0.75, P=0.01). Cox regression analysis showed that CVA-OCC (HR=1.63, P=0.02) and C-OCC (HR=3.30, P=0.001) were risk factors for ISR but not ICA-OCC (P=0.31). In the CVA-OCC and C-OCC groups, in-stent peak systolic velocity (PSV) ≥140 cm/s, 1 day after successful stenting, was associated with subsequent development of ISR (OR=2.81, 95% CI 1.06 to 7.43, P=0.04).

Conclusion Contralateral VA occlusion at the time of stenting increased the risk of ISR, especially if stent PSV on day 1 was >140 cm/s. Bare metal stents had more ISR than drug eluting stents.

  • stroke
  • ultrasound
  • stent
  • stenosis

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  • Contributors JL, YH, LN, and LJ: substantial contributions to the conception or design of the work. JL, YH, and LN: analysis and interpretation of the data. JL, LN, FF, JRE, and J-BL: drafting the work or revising it critically for important intellectual content. JL, FF, JRE, and ZL: data analysis and statistics. JL, RL, and XT: acquisition of the data. LJ and YH: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YH: final approval of the version to be published.

  • Funding The work was supported by the National Natural Science Foundation of China Grant, grant No 81070924, and by Beijing Municipal Administration of Hospitals’ Youth Programme, grant No QML20150803.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The research protocol was reviewed and approved by the ethics committee of Xuanwu Hospital, Capital Medical University.

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