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PT  - JOURNAL ARTICLE
AU  - Peng, G.
AU  - Zhang, Y.
AU  - Miao, Z.
TI  - Incidence and Risk Factors of In-Stent Restenosis for Symptomatic Intracranial Atherosclerotic Stenosis: A Systematic Review and Meta-Analysis
AID  - 10.3174/ajnr.A6689
DP  - 2020 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1447--1452
VI  - 41
IP  - 8
4099  - http://www.ajnr.org/content/41/8/1447.short
4100  - http://www.ajnr.org/content/41/8/1447.full
SO  - Am. J. Neuroradiol.2020 Aug 01; 41
AB  - 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 &amp;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.ISRin-stent restenosisMINORSMethodological Index for Non-Randomized StudiesPRISMAPreferred Reporting Items for Systematic Reviews and Meta-AnalysesSAMMPRISStenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial StenosisSESself-expandable stent