Salvage endovascular treatment for intracranial restenosis

BACKGROUND: Endovascular treatment (EVT) is an important treatment for symptomatic intracranial atherosclerotic stenosis (sICAS). However, restenosis limits its long-term efficacy, and some patients continue to experience ischemic events, requiring more aggressive interventions. OBJECTIVE: To evaluate the feasibility of using existing devices for salvage EVT of intracranial restenosis and compare the two salvage procedural approaches. METHODS: Consecutive patients with sICAS receiving salvage EVT for restenosis after primary EVT between April 2017 and April 2024 were retrospectively analyzed. RESULTS: A total of 42 patients were included in the study. All procedures were technically successful (100%), with no complications (0%). Re-restenosis (rRS) occurred in 14 patients (33.3%), and ischemic events were observed in 10 patients (23.8%). We found that patients who underwent salvage balloon angioplasty followed by stenting had a significantly lower risk of rRS than those who received salvage balloon angioplasty alone (17.4% vs 52.6%, P=0.016). Additionally, the risk of recurrent ischemic stroke was also significantly reduced (0% vs 21.1%, P=0.021). CONCLUSION: Using existing devices for salvage EVT in patients with intracranial restenosis appears feasible, with favorable safety and success rates. However, the risk of rRS and recurrent ischemic events remains relatively high. Salvage balloon angioplasty followed by stenting may provide superior long-term outcomes compared with salvage balloon angioplasty alone.