Stroke & Vascular Neurology（SVN）最新上线文章“Residual inflammatory risk predicts long-term outcomes following stenting for symptomatic intracranial atherosclerotic stenosis”，来自首都医科大学附属北京天坛医院介入神经病学科马宁教授团队。

残余炎症风险（Residual inflammatory risk, RIR）可预测轻型缺血性卒中患者不良结局。然而，对于接受支架置入术的症状性颅内动脉粥样硬化性狭窄（symptomatic intracranial atherosclerotic stenosis, sICAS）患者，术前RIR对长期结局的影响尚有待研究。

这项回顾性、单中心队列研究对接受颅内支架置入术的重度sICAS连续患者进行了评估。根据术前高敏C反应蛋白（high-sensitivity C-reactive protein, hs-CRP）和低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）将患者分为4组：残余胆固醇炎症风险（residual cholesterol inflammatory risk, RCIR; hs-CRP≥3 mg/L, LDL-C≥2.6 mmol/L），RIR（hs-CRP≥3 mg/L, LDL-C<2.6 mmol/L），残余胆固醇风险（residual cholesterol risk, RCR; hs-CRP<3 mg/L, LDL-C≥2.6 mmol/L），以及无残余风险（no residual risk, NRR; hs-CRP<3 mg/L, LDL-C<2.6 mmol/L）。长期临床结局包括复发性缺血性卒中和死亡。长期影像学结局包括支架内再狭窄（ in-stent restenosis, ISR）和支架置入后症状性ISR（sISR）。

Figure 1. (A) DSA shows a 75% stenosis of BA (left) and a 10% residual stenosis after (middle) stenting. Follow-up CTA (right) after 11 months of the procedure shows no ISR. (B) DSA shows an 80% stenosis of left MCA (left) and a 25% residual stenosis after (middle) stenting. Follow-up CTA (right) after 10 months of the procedure shows ISR. (C) DSA shows an 85% stenosis of BA (left) and a 5% residual stenosis after (middle) stenting. Follow-up DSA (right) after 12 months of the procedure shows no ISR. (D) DSA shows an 80% stenosis of C7 segment of left ICA (left) and a 20% residual stenosis after (middle) stenting. Follow-up DSA (right) after 7 months of the procedure shows ISR.

研究共纳入952例患者，其中男性751例（78.9%）。残余胆固醇炎症风险（RCIR）组46例，残余炎症风险（RIR）组211例，残余胆固醇风险（RCR）组107例，无残余风险（NRR）组588例。RCIR（校正后HR 6.163; 95%CI 2.603 to 14.589; p<0.001）和 RIR（校正后HR 2.205; 95%CI 1.294 to 3.757; p=0.004）患者复发缺血性卒中风险高于NRR患者。中位随访时间为54个月。与NRR组相较，RCIR组患者（校正后HR 3.604; 95%CI 1.431 to 9.072; p=0.007）更容易发生ISR，RIR组患者发生sISR的风险显著增加（校正后HR 2.402; 95%CI 1.078 to 5.351; p=0.032），中位影像随访时间为11.9个月。

Figure 3. (A) The Kaplan-Meier survival curve for probability of recurrent ischaemic stroke within 60 months. (B) Hazard of recurrent ischaemic stroke compared with NRR. Age (>60 or ≤60 years), gender, body mass index (>28 or ≤28 kg/m2), hypertension, diabetes mellitus, hypercholesterolaemia, coronary artery disease, smoking, baseline NIHSS (>3 or ≤3), baseline HDL-C level (≥1.03 mmol/L or <1.03 mmol/L13), periprocedural use of Tirofiban, lesion location and LDL-C during follow-up (≥1.81 mmol/L or <1.81 mmol/L) were adjusted in the multivariate Cox proportional hazards model.

Figure 4. (A) the Kaplan-Meier survival curve for probability of recurrent stroke within 60 months by using a target cut-off level of 1.8 mmol/L for LDL-C. (B) Hazard of recurrent ischaemic stroke compared with NRR. Age (>60 or ≤60 years), gender, body mass index (>28 or ≤28 kg/m2), hypertension, diabetes mellitus, hypercholesterolaemia, coronary artery disease, smoking, baseline NIHSS (>3 or ≤3), baseline HDL-C level (≥1.03 mmol/L or <1.03 mmol/L), periprocedural use of Tirofiban, lesion location and LDL-C during follow-up (≥1.81 mmol/L or <1.81 mmol/L) were adjusted in the multivariate Cox proportional hazards model.

Figure 5. (A) The Kaplan-Meier survival curve for probability of ISR within 36 months. (B) The Kaplan-Meier survival curve for probability of sISR within 36 months. (C, D) Hazard of ISR or sISR compared with NRR. Age (>60 or ≤ 60 years), gender, body mass index (>28 or ≤28 kg/m2), hypertension, diabetes mellitus, hypercholesterolaemia, coronary artery disease, smoking, baseline NIHSS (>3 or ≤3), baseline HDL-C level (≥1.03 mmol/L or <1.03 mmol/L), periprocedural use of Tirofiban, lesion location and LDL-C during follow-up (≥1.81 mmol/L or <1.81 mmol/L) were adjusted in the multivariate Cox proportional hazards model.

研究结论，在症状性颅内动脉粥样硬化性狭窄患者中，术前RIR或可预测颅内支架置入术后长期复发性缺血性卒中、支架内再狭窄及症状性支架内再狭窄。