Age and V1 Tortuosity Associated With In-Stent Restenosis Rate After V1 Segment Stenting

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Researchers sought to identify risk factors for in-stent restenosis following vertebral artery V1 segment stenting.

Young age and V1 tortuosity are associated with an increase in in‐stent restenosis (ISR) rates after vertebral V1 segment stenting, according to a study published in Catheterization & Cardiovascular Interventions.

The findings are based on a meta‐analysis and systematic review that sought to identify risk factors for ISR after V1 segment stenting.

Investigators searched the PubMed, Embase, and Cochrane Library databases from inception to September 2021. Eligible studies were retrospective and prospective English-language original articles on vertebral artery stenting for V1 segment (“ostium” or “origin”) that provided complete data for 1 or more suspected risk factors of analysis between ISR and non‐ISR groups. Pooled analyses were conducted when data of the same suspected risk factor were available for 2 or more studies.

A total of 11 studies with 1356 patients were included in the analysis, which consisted of 10 observational studies and 1 randomized controlled trial (RCT). The overall ISR rate was 19.6% (305 of 1554 arteries).

In analysis of age as a potential risk factor, 5 studies with 784 patients were used to compare patients’ age between the ISR group (n=163) and the non‐ISR group (n=621). Pooled analysis demonstrated that patients in the ISR group were significantly younger compared with those in the non‐ISR group (weighted mean difference, -1.958; 95% CI, -3.453 to -0.463; P =.01).

For V1 tortuosity, data were provided in 2 studies with 120 participants (25 ISR, 95 non‐ISR). The ISR group had more patients with V1 tortuosity (odds ratio, 4.145; 95% CI, 1.56-11.012; P =.004) vs the non-ISR group, according to the pooled analysis.

Other suspected risk factors, including bare-metal stent (BMS), stent diameter, stent length, diabetes mellitus, coronary artery disease, and smoking, were not associated with a significant increase in ISR rates. Regarding postoperative antiplatelet strategies in the included studies, the most frequently used initial regimen was dual antiplatelet therapy, which was received for 1 to 12 months.

No significant publication bias was observed in each pooled analysis.

Among several limitations, the included studies were published from 2008 to 2021, and 1 study was a RCT, which limits the quality grade of the findings. Also, analysis of more detailed stent types was not possible, and only 2 studies provided data about V1 tortuosity and drug-eluting stent diameter for pooled analysis. The overall analysis is based on limited current data, and the results could change as more data become available, the researchers noted.

“A meta‐analysis based on current data shows that younger age and V1 tortuosity are risk factors for ISR after vertebral V1 segment stenting,” wrote the study authors. “With limited data and a lack of RCTs, more detailed studies are still required.


Guo J, Ning Y, Wu S, et al. Risk factors for in‐stent restenosis after vertebral artery stenting of V1 segment: a systematic review and meta‐analysis. Catheter Cardiovasc Interv. Published online June 22, 2022. doi: 10.1002/ccd.30296