The Analysis Of Risk Factors For In-stent Restenosis After Vertebral Artery Stenting

Objective: To explore the risk factors of restenosis after stenting for vertebral artery stenosis.Methods: From September 2016 to May 2018,96 patients who underwent vertebral artery stenosis stenting in the Department of Neurology,the Fourth Affiliated Hospital of China Medical University,and completed follow-up for at least 6 months were selected as subjects.All patients were reexamined by DSA or CTA 6 months after operation,and were divided into restenosis group and non-restenosis group according to whether or not more than 50% of the stent stenosis occurred.At the same time,according to the position of the stent,all patients were divided into two subgroups: the initial part and the non-initial part.The differences of age,gender,glycosylated hemoglobin,homocysteine,low-density lipoprotein,triglyceride,history of diabetes,history of coronary heart disease,history of hypertension,preoperative and postoperative smoking history,preoperative and postoperative drinking history,preoperative stenosis rate,postoperative residual stenosis rate between restenosis group and non-restenosis group were compared both in the total and subgroup,and the statistically significant factors were included in multivariate logistic regression analysis,and independent risk factors affecting restenosis after vertebral artery stent implantation were obtained.Results:1.There were significant differences in diabetes history(P=0.027),postoperative smoking(P=0.016),blood homocysteine(P=0.015),glycosylated hemoglobin(P=0.001)between the total vertebral artery stenosis stenting restenosis group and non-stenosis group.The factors mentioned above were included in multivariate logistic regression analysis,the results showed that glycosylated hemoglobin(95%CI:1.021-12.574,OR=3.583,P=0.046),postoperative smoking(95%CI:1.358-16.849,OR=4.783,P=0.015)and homocysteine(95%CI:2.075-242.468,OR=22.43,P=0.01)were independent risk factors for restenosis after stenting for vertebral artery stenosis.2.In the initial part of vertebral artery subgroup analysis of stenosis stent implantation,there were significant differences in postoperative smoking(P=0.02),diabetes history(P=0.01),glycosylated hemoglobin(P=0.001),blood homocysteine(P=0.015)betweenrestenosis group and non-restenosis group.The above factors were included in the multivariate logistic regression analysis,the results showed that postoperative smoking(95%CI:1.192-43.665,OR=7.214,P=0.031)and blood homocysteine(95%CI:2.075-242.468,OR=22.43,P=0.01)were independent risk factors for the initial part ofvertebral artery stenosis restenosis after stent implantation.3.In the non-initial part of vertebral artery subgroup analysis of stenosis stent implantation,there was no significant difference in all factors between restenosis group and non-restenosis group(P>0.05).4.The recurrence rate of stroke in the restenosis group was higher than that in the non-restenosis group(P=0.014).Conclusion:1.Among the stent placement for overvall vertebral artery stenosis:glycated hemoglobin,postoperative smoking and homocysteine are independent risk factors for restenosis after stent implantation.2.Among subgroup analysis after stenting for the initial part of vertebral artery stenosis:postoperative smoking and homocysteine are independent risk factors for restenosis after stent implantation.3.The restenosis group was more likely to have recurrent stroke than the non-restenosis group after vertebral artery stenosis.