Higher Fibrosis-4 Index Is Associated With 1-Year In-Stent Restenosis After Carotid Artery Stenting.

Authors

Tomohiro Fujioka, Hideaki Kanki, Yasufumi Gon, Junji Takasugi, Tomohiro Kawano, Takaya Kitano, Shumpei Murakami, Shogo Furuya, Hajime Nakamura, Masatoshi Takagaki, Tomohiko Ozaki, Haruhiko Kishima, Tsutomu Sasaki, Hideki Mochizuki

Published in

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. Pages 108760. Oct 02, 2026. Epub Oct 02, 2026.

Abstract

In-stent restenosis (ISR) is a clinically important complication of carotid artery stenting (CAS); however, practical risk markers remain understudied. Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with atherosclerotic risk, and the Fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis, has been linked to carotid atherosclerosis progression. Therefore, this study examined whether the FIB-4 index was associated with ISR after CAS.
We retrospectively analyzed 132 patients who underwent CAS between 2010 and 2023. ISR was defined as peak systolic velocity ≥175 cm/s on at least two consecutive duplex examinations. The primary analysis evaluated FIB-4 continuously per 1-SD increase using Cox models. Secondary exploratory analyses used a cohort-derived cutoff determined by the Youden index.
ISR occurred in 16/132 (12%) patients. When analyzed continuously, FIB-4 was not significantly associated with ISR in univariable analysis (HR per 1-SD increase, 1.34; 95% CI, 0.88-2.04; p = 0.172) or in a parsimonious model adjusted for sex and stent design (adjusted HR, 1.40; 95% CI, 0.89-2.21; p = 0.142). The cohort-derived cutoff was 2.08. In secondary exploratory analysis, FIB-4 ≥2.08 was associated with higher ISR risk after adjustment for sex and stent design (adjusted HR, 3.93; 95% CI, 1.42-10.9; p = 0.008).
Although continuous FIB-4 was not significantly associated with ISR, exploratory cutoff-based analyses suggested an association between higher FIB-4 and 1-year ISR after CAS. Further validation is required before clinical use.

PMID:
42826851
Bibliographic data and abstract were imported from PubMed on 03 Oct 2026.

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