Incidence and Predictors of In-stent Restenosis Following Intervention for Pulmonary Vein Stenosis due to Fibrosing Mediastinitis

Background Percutaneous transluminal pulmonary venoplasty (PTPV) is an emerging treatment for pulmonary vein stenosis (PVS) caused by fibrosing mediastinitis (FM). However, the incidence and predictors of in-stent restenosis (ISR) are elusive. We sought to identify the predictors of ISR in patients with PVS caused by extraluminal compression due to FM. Methods We retrospectively enrolled patients with PVS-FM who underwent PTPV between July 1, 2018, and December 31, 2022. According to ISR status, patients were divided into two groups: the ISR group and the non-ISR group. Baseline characteristics (demographics and lesions) and procedure-related information were abstracted from patient records and analyzed. Univariate and multivariate analyses were performed to determine the predictors of ISR. Results A total of 142 stents were implanted in 134 PVs of 65 patients with PVS-FM. Over a median follow-up of 6.6 (3.4-15.7) months, 61 of 134 PVs suffered from ISR. Multivariate analysis demonstrated a significantly lower risk of ISR in PVs with a larger reference vessel diameter (RVD) (odds ratio (OR): 0.79; 95% confidence interval [CI]: 0.64 to 0.98; P =0.032), and stenosis of the corresponding pulmonary artery (Cor-PA) independently increased the risk of restenosis (OR: 3.41; 95% CI: 1.31 to 8.86; P =0.012). The cumulative ISR was 6.3%, 21.4%, and 39.2% at the 3-, 6-, and 12-month follow-ups, respectively. Conclusion ISR is very high in PVS-FM, which is independently associated with RVD and Cor-PA stenosis. Central illustration Based on the constructed prediction model, the RVD and stenosis of Cor-PA were found to be independently associated with ISR, and their sensitivity and optimal cutoff values for the prediction of restenosis are shown in (a) and (b), respectively. The risk of ISR significantly increased when PA stenosis occurred; the risk of restenosis decreased significantly when the RVD was larger than 8.4 mm.