title: Influence of vessel size and tortuosity on in-stent restenosis after stent implantation in the vertebral artery ostium.
abstract: OBJECTIVE
  Percutaneous transluminal angioplasty and stenting is emerging as an alternative for treating atherosclerotic stenosis in the vertebral artery ostium. However, in-stent restenosis (ISR) still remains a critical issue to be addressed. Little is known about the relationship between anatomic characteristics of the artery and ISR after stent implantation. In this study, we have evaluated influential factors for ISR in a cohort of the patients with stenting in the vertebral artery ostium.
  
  
  METHODS
  Sixty-one patients with 63 symptomatic lesions in vertebral artery ostium treated with stenting were enrolled onto this study. An average of 12.5 months' clinical and angiographic follow-up results were analyzed retrospectively. The possible influential factors for ISR, including conventional risk factors of cerebrovascular diseases and morphological characteristics of target lesions, were evaluated by univariate and multivariate regression analysis.
  
  
  RESULTS
  Technical success was achieved in all 63 interventional procedures. Stenosis was reduced from (mean±standard deviation) 75.5±12% before to 1±3.6% after the procedure. During the mean 12.5-month angiographic follow-up, ISR was detected in 17 treated vessels (27.0%), with 2 treated arteries (3.2%) resulting in occlusion, and a stent fracture in 1 case (1.6%). Multivariate Cox regression analysis showed that the tortuosity of V1 (hazard ratio 3.54, P=0.01) and smaller diameter of the stent (hazard ratio 3.8, P=0.04) were independent predictors of ISR.
  
  
  CONCLUSIONS
  Angioplasty and stenting for symptomatic stenosis in the vertebral artery ostium stenosis seem to be feasible and effective. Tortuosity and smaller diameter may affect ISR after stent implantation.
authors.affiliation: Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, #305 Zhongshan East Road, Nanjing, 210002, Jiangsu Province, China.
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Zhou
authors.forename: Qin
authors.initials: Q
authors.lastname: Yin
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.forename: Xuanye
authors.initials: X
authors.lastname: Yue
authors.forename: Renliang
authors.initials: R
authors.lastname: Zhang
authors.forename: Wusheng
authors.initials: W
authors.lastname: Zhu
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Fan
authors.forename: Minmin
authors.initials: M
authors.lastname: Ma
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*