Non-linear association between aneurysm size ratio and in-stent stenosis after flow diverter treatment: A retrospective cohort study of patients with unruptured aneurysms

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-15 DOI:10.1016/j.jstrokecerebrovasdis.2025.108423

Jia-He Yin , Zhi-Kun Jia , Chi Huang , Bin Luo , Yan-Chao Liu , Shi-Xing Su , Xin Zhang , Chuan-Zhi Duan

{"title":"Non-linear association between aneurysm size ratio and in-stent stenosis after flow diverter treatment: A retrospective cohort study of patients with unruptured aneurysms","authors":"Jia-He Yin , Zhi-Kun Jia , Chi Huang , Bin Luo , Yan-Chao Liu , Shi-Xing Su , Xin Zhang , Chuan-Zhi Duan","doi":"10.1016/j.jstrokecerebrovasdis.2025.108423","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and purpose</h3><div>Flow diversion (FD) treatment has emerged as an effective endovascular therapy for intracranial aneurysms, but in-stent stenosis remains a significant complication affecting patient outcomes. The size ratio (SR) of aneurysms may influence this outcome, but their relationship remains unclear. We investigate the association between intracranial aneurysm SR and in-stent stenosis after FD treatment.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 217 patients with unruptured aneurysms who underwent with flow-diversion treatment from January 2020 to January 2022. SR was the exposure variable, and in-stent stenosis within one year was the outcome. Covariates included demographic, clinical, and procedural factors. Binary logistic regression and two-piecewise linear models were used for analysis.</div></div><div><h3>Results</h3><div>Using binary logistic regression, we found that for every increase in SR by 1, there was on average an associated with a 37 % reduction in stenosis risk (RR = 0.63, 95 %CI: 0.40-0.99, <em>P</em> = 0.046). Further two-piecewise linear regression analysis identified a piecewise linear relationship between SR and in-stent stenosis with a threshold effect at SR = 3.50 (P for log likelihood ratio test = 0.037). In the low SR range (≤3.50), each unit increase in SR was significantly associated with a 54 % lower risk of in-stent stenosis (adjusted RR = 0.46, 95 % CI: 0.25-0.85, <em>P</em> = 0.013) after adjusting for potential confounders. However, in the high SR range (>3.50), this association became non-significant (adjusted RR = 1.56, 95 % CI: 0.51-4.77, <em>P</em> = 0.438).</div></div><div><h3>Conclusion</h3><div>The relationship between aneurysm SR and in-stent stenosis risk demonstrates a piecewise linear pattern with a threshold effect at SR = 3.50. Among aneurysms with SR values of 3.50 or less, each unit increase in SR corresponded to a 54 % decrease in stenosis risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108423"},"PeriodicalIF":1.8000,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke & Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1052305725002010","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background and purpose

Flow diversion (FD) treatment has emerged as an effective endovascular therapy for intracranial aneurysms, but in-stent stenosis remains a significant complication affecting patient outcomes. The size ratio (SR) of aneurysms may influence this outcome, but their relationship remains unclear. We investigate the association between intracranial aneurysm SR and in-stent stenosis after FD treatment.

Methods

This retrospective cohort study included 217 patients with unruptured aneurysms who underwent with flow-diversion treatment from January 2020 to January 2022. SR was the exposure variable, and in-stent stenosis within one year was the outcome. Covariates included demographic, clinical, and procedural factors. Binary logistic regression and two-piecewise linear models were used for analysis.

Results

Using binary logistic regression, we found that for every increase in SR by 1, there was on average an associated with a 37 % reduction in stenosis risk (RR = 0.63, 95 %CI: 0.40-0.99, P = 0.046). Further two-piecewise linear regression analysis identified a piecewise linear relationship between SR and in-stent stenosis with a threshold effect at SR = 3.50 (P for log likelihood ratio test = 0.037). In the low SR range (≤3.50), each unit increase in SR was significantly associated with a 54 % lower risk of in-stent stenosis (adjusted RR = 0.46, 95 % CI: 0.25-0.85, P = 0.013) after adjusting for potential confounders. However, in the high SR range (>3.50), this association became non-significant (adjusted RR = 1.56, 95 % CI: 0.51-4.77, P = 0.438).

Conclusion

The relationship between aneurysm SR and in-stent stenosis risk demonstrates a piecewise linear pattern with a threshold effect at SR = 3.50. Among aneurysms with SR values of 3.50 or less, each unit increase in SR corresponded to a 54 % decrease in stenosis risk.

查看原文本刊更多论文

分流治疗后动脉瘤大小比与支架内狭窄的非线性关系：一项未破裂动脉瘤患者的回顾性队列研究。

背景与目的：血流转移（FD）治疗已成为颅内动脉瘤的一种有效的血管内治疗方法，但支架内狭窄仍然是影响患者预后的重要并发症。动脉瘤的大小比（SR）可能影响这一结果，但它们之间的关系尚不清楚。我们研究FD治疗后颅内动脉瘤SR与支架内狭窄的关系。方法：本回顾性队列研究纳入了217例未破裂动脉瘤患者，这些患者于2020年1月至2022年1月接受了分流治疗。SR是暴露变量，一年内支架内狭窄是结果。协变量包括人口统计学、临床和程序因素。采用二元逻辑回归和两分段线性模型进行分析。结果：使用二元逻辑回归，我们发现SR每增加1，狭窄风险平均降低37% （RR=0.63, 95%CI: 0.40-0.99， P=0.046）。进一步的两分段线性回归分析发现，SR与支架内狭窄之间存在分段线性关系，在SR=3.50时存在阈值效应（对数似然比检验P = 0.037）。在低SR范围内（≤3.50），在调整潜在混杂因素后，SR每增加一个单位与支架内狭窄风险降低54%显著相关（校正RR = 0.46,95% CI: 0.25-0.85, P = 0.013）。然而，在高SR范围（>3.50），这种关联变得不显著（调整后RR = 1.56,95% CI: 0.51-4.77, P = 0.438）。结论：动脉瘤SR与支架内狭窄风险呈分段线性关系，SR=3.50时存在阈值效应。在SR值小于等于3.50的动脉瘤中，SR每增加一个单位，狭窄风险降低54%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.