Assessment of stent change after symptomatic intracranial artery stenosis using 3D high-resolution vessel wall imaging: A comparative study

Purpose This study aimed to assess stent lumen and vessel wall changes using 3D high-resolution vessel wall imaging (HR-VWI) in patients with intracranial atherosclerotic arterial stenosis after stenting. Patients and Methods: We followed up 33 patients after stenting for symptomatic intracranial arterial stenosis using 3D HR-VWI (pre- and post-contrast T1 weighted images [T1WI]), time-of-flight (TOF) magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). Two neuroradiologists measured the in-stent restenosis degree on three modalities. The linear association of stenosis measurements obtained by three different modalities was determined through Spearman’s correlation analysis. Between-reviewer agreement regarding the stenosis degree on HR-VWI was evaluated using the intraclass correlation coefficient (ICC). Further, we evaluated stent wall characteristics, including wall changes and enhancement on pre- and post-contrast T1WI images, respectively. Results All patients presented signal loss on TOF MRA at the stenting location. Eleven patients showed in-stent stenosis, with the stenosis degree ranging from 19–100% (occlusion). There was a strong correlation between the in-stent stenosis degrees on HR-VWI and DSA. There was excellent between-reviewer agreement in the stenosis degree (ICC: 0.97). Among the 11 patients, 9 patients presented with vessel wall thickness and enhancement while 2 patients showed intraluminal thrombosis with high-signal filling in the lumen on 3D HR-VWI. Conclusions The stenosis degree measured on 3D HR-VWI was consistent with the gold standard DSA. In patients with in-stent stenosis, 3D HR-VWI can reveal the restenosis cause to guide subsequent treatment.