title: Tissue Kallikrein Prevents Restenosis After Stenting of Severe Atherosclerotic Stenosis of the Middle Cerebral Artery: A Randomized Controlled Trial.
abstract: In-stent restenosis (ISR) following intracranial artery stenting affects long-term clinical outcome. This randomized controlled trial sought to identify the long-term efficacy of exogenous tissue kallikrein (TK) for preventing ISR after intracranial stenting of symptomatic middle cerebral artery (MCA) atherosclerotic stenosis.Sixty-one patients successfully treated with intracranial stenting for symptomatic MCA M1 segment stenosis (>70%) were enrolled and randomized into 2 groups: control group and TK group. Patients in the TK group received human urinary kallidinogenase for 7 days, followed by maintenance therapy of pancreatic kallikrein for 6 months. The primary end point was angiographically verified ISR at 6 months, and secondary end points included vascular events and death within 12 months. Endogenous TK plasma concentrations of patients were measured before stenting and at the 6-month follow-up time-point.Patients in the TK group had lower occurrence rates of ISR and vascular events than patients in the control group. There was no difference in endogenous TK levels in plasma at 6 months postoperatively between the TK and control groups. Further subgroup analysis revealed that patients without ISR had higher endogenous TK levels at baseline and lower concentrations at 6 months postoperatively compared with patients who underwent ISR.Exogenous TK is effective for the prevention of ISR after intracranial stenting.
authors.affiliation: From the Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China (RS, RZ, FY, MLi, LL, QY, YX, WL, XF, QD, QC, XC, GX, XL); Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, Fujian, China (MLin, HL); State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China (LZ); and Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China (WL).
authors.forename: Ruifeng
authors.initials: R
authors.lastname: Shi
authors.forename: Renliang
authors.initials: R
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Yang
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Qin
authors.initials: Q
authors.lastname: Yin
authors.forename: Hang
authors.initials: H
authors.lastname: Lin
authors.forename: Yunyun
authors.initials: Y
authors.lastname: Xiong
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liu
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Fan
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Dai
authors.forename: Lizhi
authors.initials: L
authors.lastname: Zhou
authors.forename: Wenya
authors.initials: W
authors.lastname: Lan
authors.forename: Qinqin
authors.initials: Q
authors.lastname: Cao
authors.forename: Xin
authors.initials: X
authors.lastname: Chen
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
mesh_terms: D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000517:prevention & control* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D020840:Tissue Kallikreins / Q000627:therapeutic use*
chemical_list: D020840:Tissue Kallikreins