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Updated: Dec 29, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Outcome of endovascular recanalization for intracranial in-stent restenosis
Kaijiang Kang1, Feng Gao2, Dapeng Mo2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Endovascular treatment for intracranial in-stent restenosis (ISR) showed acceptable short-term safety but high rates of recurrent stroke and re-ISR. Further research is needed to improve long-term outcomes for patients with intracranial arterial stenosis.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- In-stent restenosis (ISR) is a significant long-term complication following endovascular angioplasty and stenting for symptomatic intracranial arterial stenosis.
- Evaluating the safety and efficacy of endovascular treatment for intracranial ISR is crucial for managing patients with this condition.
Purpose of the Study:
- To assess the safety and efficacy of endovascular treatment in patients with intracranial in-stent restenosis (ISR).
Main Methods:
- A retrospective study of 32 patients with intracranial ISR who underwent endovascular treatment between June 2012 and August 2019.
- Periprocedural safety was evaluated by stroke, myocardial infarction, and death within 30 days.
- Long-term outcomes included recurrent stroke and re-ISR in the culprit vessel territory.
Main Results:
- Successful recanalization was achieved in 71.9% of patients.
- No periprocedural stroke, myocardial infarction, or death occurred within 30 days.
- Long-term follow-up revealed a 10.7% recurrent stroke rate and a 42.1% re-ISR rate.
Conclusions:
- Endovascular treatment for intracranial ISR demonstrates acceptable periprocedural safety.
- However, high rates of recurrent stroke and re-ISR persist, indicating a need for improved long-term management strategies.
Background And Purpose:
In-stent restenosis (ISR) is one of the long-term adverse outcomes of endovascular angioplasty and stenting for symptomatic intracranial arterial stenosis. In this study, we try to evaluate the safety and efficacy of endovascular treatment for intracranial ISR.
Methods:
We retrospectively collected patients with intracranial ISR who underwent endovascular treatment from June 2012 to August 2019 at a high-volume stroke center. Successful recanalization was defined as ≤30% residual stenosis. Stroke, myocardial infarction, and death after stenting within 30 days were used to evaluate periprocedural safety. Recurrent stroke in the territory of the culprit vessel and re-ISR in patients with clinical and vascular imaging follow-up data were used to evaluate the long-term outcome.
Results:
32 patients (59.6±7.2 years old) with ISR were recruited, including 22 patients (68.8%) treated with balloon dilatation, 8 patients (25%) with stenting, and 2 patients (6.3%) with failed procedures. Successful recanalization was achieved in 71.9% (23/32) of patients. There was no stroke, myocardial infarction or death within 30 days after the procedure. Recurrent stroke was found in 10.7% (3/28) of the patients, and re-ISR was found in 42.1% (8/19) of the patients. The re-ISR rate was lower in patients with stenting than in those with balloon dilatation (0% vs 57.1%, p=0.090), and in patients with successful recanalization than in those with unsuccessful recanalization (33.3% vs 75.0%, p=0.352), but with no statistically significant difference.
Conclusions:
The periprocedural safety of endovascular treatment for intracranial ISR may be acceptable, but the long-term rates of recurrent stroke and re-ISR remain at high levels.
