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<meta name="DC.Title" content="Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6689" />
<meta name="DC.Date" content="2020-08-01" />
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<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND: In-stent restenosis affects long-term outcome in patients with intracranial atherosclerotic stenosis.

PURPOSE: The aim of this meta-analysis was to evaluate the incidence and risk factors of in-stent restenosis.

DATA SOURCES: All literature that reported in-stent restenosis was searched on PubMed, Ovid EMBASE and Ovid MEDLINE data bases.

STUDY SELECTION: Original articles about stents for symptomatic intracranial atherosclerotic stenosis were selected.

DATA ANALYSIS: Meta-analysis was conducted to derive the pooled in-stent restenosis using a random-effects model. Meta-regression was performed to explore the risk factors predisposing to in-stent restenosis.

DATA SYNTHESIS: In total, 51 studies with 5043 patients were included. The pooled incidence rate of in-stent restenosis was 14.8% (95% CI, 11.9%–17.9%). Among the lesions with in-stent restenosis, 28.8% of them led to (95% CI, 22.0%–36.0%) related neurologic symptoms. The series in the United States had a higher in-stent restenosis rate (27.0%; 95% CI, 20.6%–33.9%) compared with those from Asia (13.6%; 95% CI, 10.3%–17.2%) and other regions as a whole (7.6%; 95% CI, 1.1%–18.1%) ( P  &lt; .01). Multiregression analysis revealed that younger patient age was related to high in-stent restenosis rates ( P  = .019), and vertebrobasilar junction location ( P  = .010) and low residual stenosis ( P  = .018) were 2 independent risk factors for symptomatic in-stent restenosis rate.

LIMITATIONS: The heterogeneity of most outcomes was high.

CONCLUSIONS: Our study showed promising results of in-stent restenosis for symptomatic atherosclerotic stenosis. Studies are needed to further expatiate on the mechanisms by which younger patient age, vertebrobasilar junction location, and low residual stenosis could increase in-stent restenosis and symptomatic in-stent restenosis, respectively.

ISR
:   in-stent restenosis
MINORS
:   Methodological Index for Non-Randomized Studies
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SAMMPRIS
:   Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis
SES
:   self-expandable stent" />
<meta name="DC.Contributor" content="G. Peng" />
<meta name="DC.Contributor" content="Y. Zhang" />
<meta name="DC.Contributor" content="Z. Miao" />
<meta name="article:published_time" content="2020-08-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND:&lt;/h3&gt;
&lt;p&gt;In-stent restenosis affects long-term outcome in patients with intracranial atherosclerotic stenosis.&lt;/p&gt;&lt;h3&gt;PURPOSE:&lt;/h3&gt;
&lt;p&gt;The aim of this meta-analysis was to evaluate the incidence and risk factors of in-stent restenosis.&lt;/p&gt;&lt;h3&gt;DATA SOURCES:&lt;/h3&gt;
&lt;p&gt;All literature that reported in-stent restenosis was searched on PubMed, Ovid EMBASE and Ovid MEDLINE data bases.&lt;/p&gt;&lt;h3&gt;STUDY SELECTION:&lt;/h3&gt;
&lt;p&gt;Original articles about stents for symptomatic intracranial atherosclerotic stenosis were selected.&lt;/p&gt;&lt;h3&gt;DATA ANALYSIS:&lt;/h3&gt;
&lt;p&gt;Meta-analysis was conducted to derive the pooled in-stent restenosis using a random-effects model. Meta-regression was performed to explore the risk factors predisposing to in-stent restenosis.&lt;/p&gt;&lt;h3&gt;DATA SYNTHESIS:&lt;/h3&gt;
&lt;p&gt;In total, 51 studies with 5043 patients were included. The pooled incidence rate of in-stent restenosis was 14.8% (95% CI, 11.9%–17.9%). Among the lesions with in-stent restenosis, 28.8% of them led to (95% CI, 22.0%–36.0%) related neurologic symptoms. The series in the United States had a higher in-stent restenosis rate (27.0%; 95% CI, 20.6%–33.9%) compared with those from Asia (13.6%; 95% CI, 10.3%–17.2%) and other regions as a whole (7.6%; 95% CI, 1.1%–18.1%) (&lt;i&gt;P &lt;/i&gt;&amp;lt; .01). Multiregression analysis revealed that younger patient age was related to high in-stent restenosis rates (&lt;i&gt;P &lt;/i&gt;= .019), and vertebrobasilar junction location (&lt;i&gt;P &lt;/i&gt;= .010) and low residual stenosis (&lt;i&gt;P &lt;/i&gt;= .018) were 2 independent risk factors for symptomatic in-stent restenosis rate.&lt;/p&gt;&lt;h3&gt;LIMITATIONS:&lt;/h3&gt;
&lt;p&gt;The heterogeneity of most outcomes was high.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our study showed promising results of in-stent restenosis for symptomatic atherosclerotic stenosis. Studies are needed to further expatiate on the mechanisms by which younger patient age, vertebrobasilar junction location, and low residual stenosis could increase in-stent restenosis and symptomatic in-stent restenosis, respectively.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2020/08/01" />
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<meta name="citation_section" content="Interventional" />
<meta name="citation_firstpage" content="1447" />
<meta name="citation_lastpage" content="1452" />
<meta name="citation_author" content="G. Peng" />
<meta name="citation_author_institution" content="aFrom the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0002-8756-7688" />
<meta name="citation_author" content="Y. Zhang" />
<meta name="citation_author_institution" content="aFrom the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital" />
<meta name="citation_author_institution" content="bBeijing Neurosurgical Institute (Y.Z.), Capital Medical University, Beijing, China" />
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<meta name="citation_author_institution" content="aFrom the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital" />
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<meta name="twitter:title" content="Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis" />
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<meta name="twitter:description" content="BACKGROUND: In-stent restenosis affects long-term outcome in patients with intracranial atherosclerotic stenosis.

PURPOSE: The aim of this meta-analysis was to evaluate the incidence and risk factors of in-stent restenosis.

DATA SOURCES: All literature that reported in-stent restenosis was searched on PubMed, Ovid EMBASE and Ovid MEDLINE data bases.

STUDY SELECTION: Original articles about stents for symptomatic intracranial atherosclerotic stenosis were selected.

DATA ANALYSIS: Meta-analysis was conducted to derive the pooled in-stent restenosis using a random-effects model. Meta-regression was performed to explore the risk factors predisposing to in-stent restenosis.

DATA SYNTHESIS: In total, 51 studies with 5043 patients were included. The pooled incidence rate of in-stent restenosis was 14.8% (95% CI, 11.9%–17.9%). Among the lesions with in-stent restenosis, 28.8% of them led to (95% CI, 22.0%–36.0%) related neurologic symptoms. The series in the United States had a higher in-stent restenosis rate (27.0%; 95% CI, 20.6%–33.9%) compared with those from Asia (13.6%; 95% CI, 10.3%–17.2%) and other regions as a whole (7.6%; 95% CI, 1.1%–18.1%) ( P  &lt; .01). Multiregression analysis revealed that younger patient age was related to high in-stent restenosis rates ( P  = .019), and vertebrobasilar junction location ( P  = .010) and low residual stenosis ( P  = .018) were 2 independent risk factors for symptomatic in-stent restenosis rate.

LIMITATIONS: The heterogeneity of most outcomes was high.

CONCLUSIONS: Our study showed promising results of in-stent restenosis for symptomatic atherosclerotic stenosis. Studies are needed to further expatiate on the mechanisms by which younger patient age, vertebrobasilar junction location, and low residual stenosis could increase in-stent restenosis and symptomatic in-stent restenosis, respectively.

ISR
:   in-stent restenosis
MINORS
:   Methodological Index for Non-Randomized Studies
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SAMMPRIS
:   Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis
SES
:   self-expandable stent" />
<meta name="og-title" property="og:title" content="Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/8/1447" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND: In-stent restenosis affects long-term outcome in patients with intracranial atherosclerotic stenosis.

PURPOSE: The aim of this meta-analysis was to evaluate the incidence and risk factors of in-stent restenosis.

DATA SOURCES: All literature that reported in-stent restenosis was searched on PubMed, Ovid EMBASE and Ovid MEDLINE data bases.

STUDY SELECTION: Original articles about stents for symptomatic intracranial atherosclerotic stenosis were selected.

DATA ANALYSIS: Meta-analysis was conducted to derive the pooled in-stent restenosis using a random-effects model. Meta-regression was performed to explore the risk factors predisposing to in-stent restenosis.

DATA SYNTHESIS: In total, 51 studies with 5043 patients were included. The pooled incidence rate of in-stent restenosis was 14.8% (95% CI, 11.9%–17.9%). Among the lesions with in-stent restenosis, 28.8% of them led to (95% CI, 22.0%–36.0%) related neurologic symptoms. The series in the United States had a higher in-stent restenosis rate (27.0%; 95% CI, 20.6%–33.9%) compared with those from Asia (13.6%; 95% CI, 10.3%–17.2%) and other regions as a whole (7.6%; 95% CI, 1.1%–18.1%) ( P  &lt; .01). Multiregression analysis revealed that younger patient age was related to high in-stent restenosis rates ( P  = .019), and vertebrobasilar junction location ( P  = .010) and low residual stenosis ( P  = .018) were 2 independent risk factors for symptomatic in-stent restenosis rate.

LIMITATIONS: The heterogeneity of most outcomes was high.

CONCLUSIONS: Our study showed promising results of in-stent restenosis for symptomatic atherosclerotic stenosis. Studies are needed to further expatiate on the mechanisms by which younger patient age, vertebrobasilar junction location, and low residual stenosis could increase in-stent restenosis and symptomatic in-stent restenosis, respectively.

ISR
:   in-stent restenosis
MINORS
:   Methodological Index for Non-Randomized Studies
PRISMA
:   Preferred Reporting Items for Systematic Reviews and Meta-Analyses
SAMMPRIS
:   Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis
SES
:   self-expandable stent" />
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    <title>Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node77458--5" data-node-nid="77458" id="top-node-77458--61542885163" data-pisa="ajnr;41/8/1447" data-pisa-master="ajnr;ajnr.A6689" data-apath="/ajnr/41/8/1447.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">G. Peng</span>, <span class="highwire-citation-author" data-delta="1">Y. Zhang</span> and <span class="highwire-citation-author" data-delta="2">Z. Miao</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1447-1452; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6689 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-77458--61542885163" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">G. Peng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BPeng%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Peng%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BPeng%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8756-7688" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Peng</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Y. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Beijing Neurosurgical Institute (Y.Z.), Capital Medical University, Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6058-8702" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Zhang</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Z. Miao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Interventional Neuroradiology Center (G.P., Y.Z., Z.M.), Beijing Tiantan Hospital</div><div class='author-affiliation'><span class='nlm-sup'>c</span>China National Clinical Research Center for Neurological Diseases (Z.M.), Beijing, China.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Z.%2BMiao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Miao%20Z&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AZ.%2BMiao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9642-9415" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Z. Miao</a></li></ul></div></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2020 </div></div>
      
      
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      <div class="highwire-cite-title">Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Peng</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Miao</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1447-1452; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6689 </span></div>
  
  
  
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      <div class="highwire-cite-title">Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Peng</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Y.</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Miao</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1447-1452; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6689 </span></div>
  
  
  
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