Objective This retrospective single-center study evaluates whether high-resolution magnetic resonance vessel wall imaging (HR-VWI) plaque features can predict in-stent restenosis (ISR) before stent implantation. Materials and methods Consecutive intracranial atherosclerotic disease (ICAD) patients undergoing HR-VWI and endovascular treatment from March 2018 to June 2024 were analyzed. ISR was defined as > 50% stenosis within or near (< 5 mm) the stent and > 20% absolute luminal loss. Multivariate logistic regression identified independent ISR risk factors, developing a prediction model and diagnostic nomogram. ISR-free survival was evaluated using Kaplan–Meier curves. Results Among 217 patients (mean age 64.5 ± 10.2 years; 73.2% male), 50 (23.0%) developed ISR within 1 year. Plaque eccentricity (odds ratio (OR), 32.661; 95% confidence interval (CI): 3.726–286.334; p = 0.002), higher plaque-to-pituitary stalk contrast ratio (CR) (OR, 2.702; 95% CI: 1.098–6.649; p = 0.03), and lower lymphocyte-to-monocyte ratio (OR, 0.251; 95% CI: 0.106–0.594; p = 0.002) were independent ISR predictors. The model’s AUC was 0.783 (95% CI: 0.683–0.883) for modeling and 0.827 (95% CI: 0.717–0.936) for validation, with a 0.3 cutoff. Kaplan–Meier analysis showed higher 12-month restenosis-free rates for patients with plaque eccentricity < 0.57 (68.5% vs. 27.7%; p < 0.001), CR < 38.22 (76.6% vs. 34.4%; p < 0.001) and lymphocyte-to-monocyte ratio ≥ 3.27 (70.4% vs. 37.6%; p < 0.001). Conclusions In symptomatic ICAD patients, ISR was linked to plaque eccentricity, elevated CR on HR-VWI, and reduced lymphocyte-to-monocyte ratio. These single-center findings may optimize therapeutic strategies and reduce restenosis risk, though further validation is needed to confirm their generalizability and reliability. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Can clinical and imaging biomarkers predict in-stent restenosis (ISR) in symptomatic intracranial atherosclerotic stenosis (ICAD) to guide preprocedural risk stratification? <Emphasis Type="BoldItalic">Findings</Emphasis> Plaque eccentricity, high plaque-to-pituitary stalk contrast ratio, and low lymphocyte-to-monocyte ratio independently predict ISR; our nomogram achieved 75% sensitivity and 82.6% specificity. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Preprocedural ISR prediction enables personalized strategies (e.g., stent optimization, targeted anti-inflammatory therapy), potentially reducing restenosis and stroke recurrence risk in ICAD patients undergoing stenting. Graphical Abstract

Plaque features for the prediction of in-stent restenosis in symptomatic intracranial atherosclerotic stenosis from a retrospective single-center study

期刊论文
发表日期：

2025年11月21日

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Tianhao Hu,
Runjianya Ling,
Xiaoyi Xue,
Yajie Tang,
Sheng Guo,
Yining Tao,
Yueqi Zhu

摘要

Objective

This retrospective single-center study evaluates whether high-resolution magnetic resonance vessel wall imaging (HR-VWI) plaque features can predict in-stent restenosis (ISR) before stent implantation.

Materials and methods

Consecutive intracranial atherosclerotic disease (ICAD) patients undergoing HR-VWI and endovascular treatment from March 2018 to June 2024 were analyzed. ISR was defined as > 50% stenosis within or near (< 5 mm) the stent and > 20% absolute luminal loss. Multivariate logistic regression identified independent ISR risk factors, developing a prediction model and diagnostic nomogram. ISR-free survival was evaluated using Kaplan–Meier curves.

Results

Among 217 patients (mean age 64.5 ± 10.2 years; 73.2% male), 50 (23.0%) developed ISR within 1 year. Plaque eccentricity (odds ratio (OR), 32.661; 95% confidence interval (CI): 3.726–286.334; p = 0.002), higher plaque-to-pituitary stalk contrast ratio (CR) (OR, 2.702; 95% CI: 1.098–6.649; p = 0.03), and lower lymphocyte-to-monocyte ratio (OR, 0.251; 95% CI: 0.106–0.594; p = 0.002) were independent ISR predictors. The model’s AUC was 0.783 (95% CI: 0.683–0.883) for modeling and 0.827 (95% CI: 0.717–0.936) for validation, with a 0.3 cutoff. Kaplan–Meier analysis showed higher 12-month restenosis-free rates for patients with plaque eccentricity < 0.57 (68.5% vs. 27.7%; p < 0.001), CR < 38.22 (76.6% vs. 34.4%; p < 0.001) and lymphocyte-to-monocyte ratio ≥ 3.27 (70.4% vs. 37.6%; p < 0.001).

Conclusions

In symptomatic ICAD patients, ISR was linked to plaque eccentricity, elevated CR on HR-VWI, and reduced lymphocyte-to-monocyte ratio. These single-center findings may optimize therapeutic strategies and reduce restenosis risk, though further validation is needed to confirm their generalizability and reliability.

Key Points

Question Can clinical and imaging biomarkers predict in-stent restenosis (ISR) in symptomatic intracranial atherosclerotic stenosis (ICAD) to guide preprocedural risk stratification?

Findings Plaque eccentricity, high plaque-to-pituitary stalk contrast ratio, and low lymphocyte-to-monocyte ratio independently predict ISR; our nomogram achieved 75% sensitivity and 82.6% specificity.

Clinical relevance Preprocedural ISR prediction enables personalized strategies (e.g., stent optimization, targeted anti-inflammatory therapy), potentially reducing restenosis and stroke recurrence risk in ICAD patients undergoing stenting.

Graphical Abstract