Risk factors for in-stent restenosis of vertebral artery origin after stent implantation: a Meta-analysis

Abstract

Objective To systematically review the risk factors for in-stent restenosis (ISR) of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment.  Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS) and Stata 12.0 software.  Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440) and non-ISR group (N = 912). The ISR incidence rate of smokers was significantly higher than non-smokers ( OR = 2.179, 95%CI: 1.373-3.458; P = 0.001). The differences of bare metal stents (BMS) utilization rate ( OR = 2.072, 95% CI: 1.560-2.753; P = 0.000) and drug-eluting stents (DES) utilization rate ( OR = 0.483, 95% CI: 0.363-0.641; P = 0.000) between ISR group and non-ISR group were statistically significant.  Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004