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Ischemic stroke
Original research
Incidence and predictors of restenosis following successful recanalization of non-acute internal carotid artery occlusion in 252 cases
  1. Guangdong Lu1,2,
  2. Junqing Wang3,4,
  3. Tao Wang3,
  4. Xinjuan Xu5,
  5. Xin Li6,
  6. Xinyi Sun3,
  7. Zhengyu Wang3,
  8. Jichang Luo3,
  9. Yan Ma3,
  10. Bin Yang7,
  11. Peng Gao8,
  12. Yabing Wang3,
  13. Yanfei Chen3,
  14. Sheng Liu2,
  15. Liqun Jiao1
  1. 1Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
  2. 2Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China
  3. 3Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
  4. 4Department of Neurosurgery, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China
  5. 5Department of Neurosurgery, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
  6. 6Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China
  7. 7Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
  8. 8Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China
  1. Correspondence to Dr Liqun Jiao, Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China; liqunjiao{at}sina.cn; Dr Sheng Liu, Department of Interventional Radiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, China; liusheng{at}njmu.edu.cn

Abstract

Background Data concerning restenosis following successful recanalization of non-acute internal carotid artery occlusion (ICAO) are scarce. This study was conducted to identify the incidence and predictors of restenosis following successful recanalization of non-acute ICAO.

Methods We reviewed the incidence of restenosis (defined as >70% restenosis or reocclusion) among 252 consecutive patients with successful recanalization of non-acute ICAO. Baseline, imaging, and surgery-related characteristics were analyzed to assess their association with restenosis. A scoring system was developed to identify high-risk patients for restenosis.

Results During a median follow-up of 12.6 months, restenosis occurred in 56 patients (22.2%), including 39 with reocclusion and 17 with >70% restenosis. The cumulative restenosis rate was 18.0% at 12 months and 24.1% at 24 months. The incidence of stroke was higher in patients with restenosis (25.0% vs 1.5%, P<0.01). Multivariate analysis showed occlusion length (5–10 cm vs <5 cm (hazard ratio (HR) 3.15, 95% confidence interval (95% CI) 1.07 to 9.29); ≥ 10 cm vs <5 cm (HR 5.01, 95% CI 1.73 to 14.49)), residual stenosis ≥30% (HR 3.08, 95% CI 1.79 to 5.30), and internal carotid artery (ICA) wall collapse (HR 1.96, 95% CI 1.12 to 3.44) as independent predictors of restenosis. Point scores proportional to model coefficients were assigned, with scores ranging from 0 to 6. Patients scoring 3–6 had a 4.00 times higher chance of developing restenosis (95% CI 2.35 to 6.79) compared with those scoring 0–2.

Conclusions Nearly one in five patients experienced restenosis following successful recanalization of non-acute ICAO. Occlusion length, residual stenosis ≥30%, and ICA wall collapse were independently associated with restenosis.

  • Intervention
  • Stroke
  • Stenosis
  • Atherosclerosis

Data availability statement

Data are available upon reasonable request. Additional data can be made available via the corresponding author to qualified researchers upon reasonable request (liqunjiao@sina.cn).

https://doi.org/10.1136/jnis-2024-021553

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    Data availability statement

    Data are available upon reasonable request. Additional data can be made available via the corresponding author to qualified researchers upon reasonable request (liqunjiao@sina.cn).

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    Footnotes

    • GL and JW are joint first authors.

    • GL and JW contributed equally.

    • Collaborators None.

    • Contributors Concept and design: Liqun Jiao, Sheng Liu and Guangdong Lu. Data collection：Guangdong Lu, Junqing Wang, Xinjuan Xu, Xin Li, Xinyi Sun, Zhengyu Wang and Jichang Luo. Drafting of the manuscript: Guangdong Lu, Junqing Wang and Tao Wang. Critical revision of the manuscript: Liqun Jiao and Sheng Liu. Statistical analysis: Guangdong Lu and Tao Wang. Supervision: Yan Ma, Bin Yang, Peng Gao, Yabing Wang and Yanfei Chen. Liqun Jiao is the study guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • 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.