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. 2022 Jul 27:2022:6951302.
doi: 10.1155/2022/6951302. eCollection 2022.

Hemodynamic and Geometric Risk Factors for In-Stent Restenosis in Patients with Intracranial Atherosclerotic Stenosis

Xiaowen Song  1   2   3   4 , Hancheng Qiu  1   2   3   4 , Shuo Wang  1   2   3   4 , Yong Cao  1   2   3   4 , Jizong Zhao  1   2   3   4
Affiliations

Hemodynamic and Geometric Risk Factors for In-Stent Restenosis in Patients with Intracranial Atherosclerotic Stenosis

Xiaowen Song et al. Oxid Med Cell Longev. .

Retraction in

Abstract

Methods: Severe ICAS patients managed with percutaneous transluminal angioplasty and stenting (PTAS) were included in the retrospective cohort study and were divided into two groups according to whether ISR occurred at follow-up (ISR group and no-ISR group). Computational fluid dynamics models were built based on digital subtraction angiography before and after PTAS to simulate blood flow and quantify hemodynamic parameters. The associations between vessel geometry, hemodynamics, and ISR in ICAS patients were investigated.

Results: Among 39 patients, ISR occurred in seven patients (17.95%) after a mean follow-up period of 6.69 ± 3.24 months. Stenting decreased vessel angulation (51.11° [40.07°-67.27°] vs. 15.97° [0.00°-36.16°], P = 0.000) and vessel tortuosity (0.09 [0.06-0.13] vs. 0.01 [0.00-0.03], P = 0.000). Meanwhile, the translational pressure ratio (PR) dramatically increased (0.07 [0.00-0.31] vs. 0.62 [0.41-0.82], P = 0.000) with the wall shear stress ratio decreased (13.93 [8.37-40.30] vs. 2.90 [1.69-4.48], P = 0.000). In the multivariate analysis, smaller Δ tortuosity (P = 0.038) was independently associated with the occurrence of ISR, and smaller post-PTAS translesional PR was also a predictive factor of marginal significance (P = 0.059).

Conclusion: PTAS decreased vessel angulation, vessel tortuosity, and translesional wall shear stress ratio while it increased translesional pressure ratio (PR) dramatically in ICAS patients. Smaller Δ tortuosity was found to be a risk factor for ISR, and smaller post-PTAS translesional PR was also a predictive factor of marginal significance, indicating that both geometric and hemodynamic parameters played important roles in the occurrence of ISR after PTAS.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
Research flow chart. ICAS: intracranial atherosclerotic stenosis; PTAS: percutaneous transluminal angioplasty and stenting; ISR: in-stent restenosis.
Figure 2
Figure 2
A patient-specific model reconstructed from DSA images and the generated centerlines of the proximal and distal vessel to the local stenosis before and after PTAS. The vessel angulation is referred to as the angle between the centerlines (displayed by dotted arrows). DSA: digital subtraction angiography; PTAS: percutaneous transluminal angioplasty and stenting.
Figure 3
Figure 3
Centerline extracted from the interested vessel. Vessel tortuosity is defined as T/D − 1, where T, equal to T1 + T2, is the length of the centerline between two points proximal and distal to the local stenosis, respectively, and D is the straight-line distance between these 2 points.
Figure 4
Figure 4
A patient-specific three-dimensional geometry of the arteries of interest reconstructed from DSA source images and the mesh created on the vessel surface and within the vessel lumen. DSA: digital subtraction angiography.
Figure 5
Figure 5
CFD models showing distribution of pressure, WSS, and SSR across a 90% stenotic lesion over the left MCA-M1 before and after PTAS. (a) Shows a significant decrease of pressure distal to the lesion and a significant elevated WSS and SSR adjacent to the stenotic throat before PTAS. (b) Displays increased pressure and decreased WSS and SSR adjacent to the stenotic throat after PTAS. CFD: computational fluid dynamics; WSS: wall shear stress; SSR: shear strain rate; MCA: middle cerebral artery; PTAS: percutaneous transluminal angioplasty and stenting.
Figure 6
Figure 6
(a, b) Show a 68-year-old man diagnosed with a severe right MCA-M1 stenosis, with pretreatment vessel angulation of 76.62°. After PTAS, the vessel angulation was 56.40°. 4 months later, vessel angulation was 51.53°. (c, d) Show a 62-year-old man having a severe basilar stenosis, with pretreatment vessel angulation of 35.65°. Following PTAS, vessel angulation changed to 19.76°. At 6.5-month follow-up, vessel angulation was 16.96°.
Figure 7
Figure 7
The scatterplots of correlations between hemodynamic indices. (a) Shows the correlation between WSSstenotic-apex and PG before and after PTAS. (b) Shows the correlation between translesional PR and WSSR before and post PTAS. WSS: wall shear stress; PR: pressure ratio; WSSR: wall shear stress ratio; PTAS: percutaneous transluminal angioplasty and stenting.
Figure 8
Figure 8
The scatterplots of correlations between geometric and hemodynamic metrics. (a) Shows the correlation between vessel tortuosity and WSSR after PTAS. (b) Shows the correlation between vessel tortuosity and translational PR after PTAS. WSSR: wall shear stress ratio; PR: pressure ratio; PTAS: percutaneous transluminal angioplasty and stenting.
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