Article Text

Download PDFPDF
Case series
Macrocalcification of intracranial vertebral artery may be related to in-stent restenosis: lessons learned from optical coherence tomography
  1. Ran Xu1,2,
  2. Bin Yang1,2,
  3. Long Li1,2,
  4. Tao Wang1,2,
  5. Xia Lu1,2,
  6. Jichang Luo1,2,
  7. Xiao Zhang1,2,
  8. Jia Dong3,
  9. Yabing Wang1,2,
  10. Yang Hua4,
  11. Yan Ma1,2,
  12. Liqun Jiao1,2,3
  1. 1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
  2. 2China International Neuroscience Institute (China-INI), Beijing, People's Republic of China
  3. 3Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
  4. 4Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
  1. Correspondence to Dr Liqun Jiao, Department of Neurosurgery, Xuanwu Hospital, Beijing 100053, China; liqunjiao{at}; Dr Yan Ma; leavesyan{at}


Background Calcification has been proven to be a marker of atherosclerosis and is related to an increased risk of ischemic stroke. Additionally, calcification was reported to be prevalent in patients with stenotic lesions of the intracranial vertebral artery. Thus, reliable imaging facilities for evaluating plaque calcification have remarkable significance in guiding stenting and predicting patient outcomes. Optical coherence tomography (OCT) has a unique advantage in its ability to detect calcium and to achieve three-dimensional volumetric calcium characterization.

Methods From March 2017 to September 2018, seven cases of calcified lesions with intracranial vertebral artery stenosis were investigated using OCT, before and after the placement of an Apollo balloon-mounted stent. Transcranial color-coded duplex sonography was performed to identify restenosis with a mean follow-up time of 13.3 months in this case series.

Results All calcified lesions were evaluated quantitatively and qualitatively using OCT. Among all cases, five had macrocalcifications and two had spotty calcifications. Severe in-stent restenosis was observed in two cases, both with macrocalcifications.

Conclusions This study suggests a potential relationship between macrocalcifications and the risk of in-stent restenosis of the intracranial vertebral artery. These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.

  • stenosis
  • atherosclerosis
  • plaque
  • stroke

Statistics from


  • Contributors Conception and design: RX, BY, YM and LJ; development of methodology: LL, TW, XZ, JL; acquisition of data: JD; analysis and interpretation of data: RX, BY, LL; writing of the manuscript: RX, BY; study supervision: YW, YH, YM and LJ.

  • Funding This work was supported by the Ministry of Science and Technology of the People’s Republic of China (2016YFC1301700), the Beijing Scientific and Technologic Project (Z201100005520019, Z201100005520020), Capital Medical University Science Program for Fostering Young Scholars (1210020222), Xuanwu Hospital Science Program for Fostering Young Scholars (QNPY2020010, XWJL-2018015).

  • Competing interests None declared.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.