title: In-stent stenosis after stent-assisted coiling:  incidence, predictors and clinical outcomes of 435 cases.
abstract: BACKGROUND
  Neuroform and Enterprise are widely used self-expanding stents designed to treat wide-necked intracranial aneurysms.
  
  
  OBJECTIVE
  To assess the incidence, clinical significance, predictors, and outcomes of in-stent stenosis (ISS).
  
  
  METHODS
  Angiographic studies and hospital records were retrospectively reviewed for 435 patients treated between 2005 and 2011 in our institution. A multivariable regression analysis was conducted to determine the predictors of ISS.
  
  
  RESULTS
  The Neuroform stent was used in 264 patients (60.7%) and the Enterprise in 171 patients (39.3%). A total of 11 patients (2.5%) demonstrated some degree of ISS during the follow-up period at a mean time point of 4.2 months (range, 2-12 months). The stenosis was mild (< 50%) in 8 patients (1.8%), moderate (50-75%) in 2 patients (0.5%), and severe (> 75%) in 1 patient (0.2%). No patients were symptomatic or required further intervention. There was complete ISS resolution in 2 patients, partial resolution in 2 patients, and no change in 5 patients on follow-up angiography. Patients developing ISS were significantly younger than those without ISS (40.3 vs. 54.9 years; P < .001). ISS rates were 2.7% with the Neuroform and 2.3% with the Enterprise stent (P = .6). In multivariable analysis, younger patient age (odds ratio = 0.92; P = .008), carotid ophthalmic aneurysm location (odds ratio = 7.7; P =0.01), and carotid terminus aneurysm location (odds ratio = 8.1; P = .009) were strong independent predictors of ISS. The type of stent was not a predictive factor.
  
  
  CONCLUSIONS
  Neuroform and Enterprise ISS is an uncommon, often transient, and clinically benign complication. Younger patients and those harboring anterior circulation aneurysms located at ophthalmic and carotid terminus locations are more likely to develop ISS.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.forename: Ross
authors.initials: R
authors.lastname: Drueding
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006083:Graft Occlusion, Vascular; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D016017:Odds Ratio; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult