The Relationship Between Reoperative Prognostic Nutritional Index Levels And Risk Of In-Stent Restenosis Following Cerebrovascular Bare-Metal Stent Implantation

Objective: In-stent restenosis(ISR)is a key parameter influencing long-term stent use in patients that have undergone cerebrovascular stent implantation,and it additionally impacts surgical treatment outcomes.Inflammation is a important driver of ISR incidence.However,no study have evaluated the relationship between ISR and prognostic nutritional index(PNI),which is based upon lymphocyte counts and serum albumin levels and is closely linked with inflammatory activity.In this study,we therefore assessed whether PNI levels upon admission were predictive of ISR incidence.Methods :The PNI values of patients with selective cerebral vascular stent implantation in our hospital from December 2017 to May 2020 were retrospectively analyzed according to preoperative serum albumin(ALB)and peripheral blood lymphocyte count(TLC).In total,141 patients with a history of intracranial artery stent implantation(19.9% female;)were analyzed in this study.ISR was diagnosed based upon a > 50% narrowing of the blood vessel at the site of stenting relative to the diameter following the most recent intervention.Based on these criteria,patients were separated into ISR and restenosis-free groups.The demographic baseline characteristics and laboratory parameters were compared between the two groups,and the factors with statistical differences between the two groups were analyzed by regression analysis to find out the factors influencing in stent restenosis,and the receiver operating characteristic curve(ROC curve)of related factors was used to analyze the value of predicting restenosis.Results: In stent restenosis occurred in 36 patients(25.5%).The levels of PNI,lymphocyte and albumin in ISR group were lower than those in no ISR group(P < 0.05).Binary regression analysis showed that elevated PNI and lymphocyte levels were protective factors for in stent restenosis(P < 0.05),while albumin level was not associated with in stent restenosis(P > 0.05).The best cut-off value of PNI for predicting in stent restenosis was 52.5,the sensitivity was 80.6%,and the specificity was 67.6%(AUC: 0.772,95% CI:0.679-0.865,P < 0.05).Conclusions: Low preoperative PNI level and low lymphocyte count were independent predictors of restenosis of bare metal stent.