Residual inflammatory risk predicts long-term outcomes following stenting for symptomatic intracranial atherosclerotic stenosis

Ying Yu; Yake Lou; Yuesong Pan; Long Yan; Weilun Fu; Zhikai Hou; Rongrong Cui; Zhongrong Miao; Yongjun Wang; Xin Lou; Ning Ma

doi:10.1136/svn-2023-002421

Residual inflammatory risk predicts long-term outcomes following stenting for symptomatic intracranial atherosclerotic stenosis

Stroke Vasc Neurol. 2023 Aug 28:svn-2023-002421. doi: 10.1136/svn-2023-002421. Online ahead of print.

Authors

Ying Yu^{1

2

3}, Yake Lou⁴, Yuesong Pan², Long Yan^{1

2}, Weilun Fu^{1

2}, Zhikai Hou^{1

2}, Rongrong Cui⁵, Zhongrong Miao^{1

2

3}, Yongjun Wang², Xin Lou⁶, Ning Ma^{7

2

3}

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Beijing, China.
³ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁴ Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Neurology, Beijing Daxing District People's Hospital, Beijing, China.
⁶ Radiology, Chinese PLA General Hospital, Beijing, China.
⁷ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China maning_03@hotmail.com.

PMID: 37640497
DOI: 10.1136/svn-2023-002421

Abstract

Background and purpose: Residual inflammatory risk (RIR) can predict the unfavourable outcomes in patients with minor ischaemic stroke. However, the impact of preprocedural RIR on long-term outcomes in patients with symptomatic intracranial atherosclerotic stenosis (sICAS) who underwent stenting remains understudied.

Methods: This retrospective, single-centre cohort study evaluated consecutive patients with severe sICAS who underwent intracranial stenting. Patients were categorised into four groups based on preprocedural high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L) and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). The long-term clinical outcomes included recurrent ischaemic stroke and death. The long-term imaging outcomes consisted of in-stent restenosis (ISR) and symptomatic ISR (sISR) after stenting.

Results: In this study, 952 patients were included, with 751 (78.9%) being male. Forty-six cases were categorised into the RCIR group, 211 into the RIR group, 107 into the RCR group and 588 into the NRR group. Patients with RCIR (adjusted HR 6.163; 95% CI 2.603 to 14.589; p<0.001) and RIR (adjusted HR 2.205; 95% CI 1.294 to 3.757; p=0.004) had higher risks of recurrent ischaemic stroke than those with NRR during the 54 months of median follow-up time. Patients with RCIR (adjusted HR 3.604; 95% CI 1.431 to 9.072; p=0.007) were more likely to occur ISR, and patients in the RIR group showed a significant increase in the risk of sISR (adjusted HR 2.402; 95% CI 1.078 to 5.351; p=0.032) compared with those in the NRR group with a median follow-up time of 11.9 months.

Conclusions: In patients with sICAS, preprocedural RIR may predict long-term recurrent ischaemic stroke, ISR and sISR following intracranial stenting.

Keywords: atherosclerosis; inflammation; risk factors; stents; stroke.