| Objective: To explore the correlation between vessel diameter and in-stent restenosis(ISR)after stenting of extracranial arteries above the aortic arch,and to provide an effective treatment for preventing in-stent restenosis.Methods: Enrolled patients who underwent carotid artery and vertebral artery stenting in the Fourth Affiliated Hospital of Nanjing Medical University from October 2017 to March 2019 were collected retrospectively.To analyze the demographic characteristics,laboratory examination results,imaging characteristics of blood vessels,vessel diameter,stent type,time of using antithrombotic medicine,etc.The patients were followed up every 6 months after operation,and brain angiography,head and neck computed tomography angiography or neck vascular ultrasound were reexamined to judge whether there was in-stent restenosis.The degree of vascular stenosis was evaluated by the North American Symptomatic Carotid Endarterectomy Trial Collaborators(NASCET),and relevant data were recorded.The digital subtraction angiography was used as the gold standard to judge in-stent restenosis.According to the actual existence of in-stent restenosis,they were divided into restenosis group and non-stenosis group.Baseline and clinical data of the two groups were compared and analyzed,analyzed the independent risk factors of in-stent restenosis by multivariate Logistic regression.The time of taking dual antiplatelet aggregation in patients with carotid artery and vertebral artery(within 28 days,3 months and 6 months)was recorded,and then a single drug was taken until the final follow-up time.To analyze the differences of in-stent restenosis caused by different treatment schemes of dual antiplatelet aggregation.The data of recurrent cerebrovascular diseases,such as transient ischemic attack,acute cerebral infarction or cerebral hemorrhage,were recorded.Results: A total of 265 stents were included,including 127 carotid arteries and138 vertebral arteries.Follow-up(15.2±4.5)months(range 6 ～ 24 months),there was no statistical difference in follow-up time and demographics between the two groups(P > 0.05).Among all the vessels,8(6.3%)carotid arteries had in-stent restenosis,and 24(17.3%)vertebral arteries had in-stent restenosis.Univariate analysis showed that diabetes,smoking,stenosis degree,low density lipoprotein cholesterol,residual stenosis,vessel diameter and stent location were significantly different between …and ….Multivariate Logistic regression analysis showed that the vessels diameter(OR = 1.738,95% CI: 1.294 ～ 2.336,P < 0.001),residual stenosis(OR = 1.225,95%CI: 1.081 ～ 1.390,P = 0.002),diabetes history(OR = 2.561,95% CI:1.474 ～ 4.448,P = 0.001),smoking history(OR = 3.575,95% CI: 1.042 ～ 12.258,P = 0.043)were independent risk factors for in-stent restenosis after stenting in different sites,and the of vessels diameter was negatively correlated with restenosis after stenting.The double anti-platelet aggregation treatment time was 28 days,3 months and 6 months,follow-up(ranging from 6 months to 24 months)showed that the restenosis rates of vertebral artery groups were 28.6%,19.1% and 14.3%,and carotid artery groups were10.0%,6.2% and 5.8%,respectively.There were 10 cerebrovascular events(3.8%)during the follow-up period,including 3 cerebral infarction,1 cerebral hemorrhage and 6 transient ischemic attack.Conclusion:The diameter of blood vessels was closely related to in-stent restenosis after extracranial artery stenting.Restenosis rate after vertebral artery stenting was higher than that of carotid artery.The smaller the diameter of blood vessels,the greater the possibility of restenosis after stenting,which was the reason for different restenosis rates of blood vessels with diverse diameters.In the treatment of vertebral artery stenosis,the use of drug-eluting stent may be an effective method to reduce in-stent restenosis of vertebral artery. |
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