title: Higher risk of recurrent ischemic events in patients with intracranial in-stent restenosis.
abstract: OBJECTIVE
  Reliable data concerning prognosis of patients with intracranial in-stent restenosis (ISR) is lacking. We prospectively studied long-term outcomes of patients with and without a catheter angiography-verified ISR.
  
  
  METHODS
  Between September 2001 and May 2009, 540 consecutive patients with symptomatic intracranial atherosclerosis received stenting treatment at our institute. Of them, 226 patients with 233 stented arteries had catheter angiography follow-up after stenting and were enrolled into this study. They were clinically followed up until the end of December 2011. Primary end point was ischemic stroke or transient ischemic attack in the territory of the stented artery after the catheter angiography follow-up. ISR was defined as a catheter angiography-verified stenosis of ≥50% within or immediately adjacent (within range of 3 mm) to the implanted stent.
  
  
  RESULTS
  During a mean follow-up of 38.9 months, 27 (11.6%, 27/233) primary end point events were recorded. The risk of primary end point in ISR group was higher compared with non-ISR group (21.1% [12/57] versus 8.5% [15/176]; hazard ratio, 2.94; 95% confidence interval, 1.37-6.30; P=0.005). Multivariable analysis showed that the ISR was an independent risk factor for the primary end point (hazard ratio, 2.79; 95% confidence interval, 1.20-6.49; P=0.017). The median occurrence time of primary end point was 9.9 (interquartile range, 5.0, 21.1) months in ISR group, earlier than that in non-ISR group (26.6 [13.1, 52.9] months; P=0.01).
  
  
  CONCLUSIONS
  In-stent restenosis after stenting of intracranial atherosclerosis is significantly associated with an increased risk and an earlier occurrence of recurrent ischemic events in the territory of the stented intracranial artery.
authors: From the New Era Stroke Care and Research Institute, the Second Artillery General Hospital PLA, Beijing, China (M.J., B.D., W.-J.J.); Institute of Neurosciences, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China (X.F.); and the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, the Capital Medical University, Beijing, China (Y.W., X.-T.-X.).
authors: Min
authors: M
authors: Jin
authors: Xian
authors: X
authors: Fu
authors: Yuzhen
authors: Y
authors: Wei
authors: Bin
authors: B
authors: Du
authors: Xiao-Tong
authors: XT
authors: Xu
authors: Wei-Jian
authors: WJ
authors: Jiang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D057785:Catheters; D002533:Cerebral Angiography / Q000379:methods; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: angioplasty; intracranial arterial disorders; natural history; outcome measures