Drug-Eluting stents in the treatment of proximal vertebral artery stenosis

Abstract

The objective of the study was to assess the efficacy of endovascularrevascularization with drug-eluting stents in patients withproximal atherosclerotic stenosis of the vertebral arteries. Westudied 32 subjects (6110 years) who underwent 35 interventionsof sirolimus- or tacrolimus-coated stent placement(3 patients were operated on both vertebral arteries). Twentyseven(84%) patients were symptomatic. All patients receiveddouble antiplatelet therapy after the intervention. The interventionwas technically successful in 89% cases. No cases of acutestroke, myocardial infarction or death were seen in the perioperativeperiod. Ultrasound scanning showed that stentsremained completely patent. Twenty-nine (91%) subjects with32 stents were followed-up for a mean period of 9.5 months. Noacute strokes in the vertebral basin were reported, althoughrecurrent symptoms were noted in 3 patients. In-stent restenosiswas found in 16 (50%) vertebral arteries in 15 patients, and itwas asymptomatic in 12 (80%) cases. Restenosis 50% (n=13)and re-occlusion (n=3) were seen more often in the tacrolimuselutingstents compared to the sirolimus-eluting stents (10 outof 14 cases [71%] vs. 6 out of 18 cases [33%], р=0.1794). Stentdamage followed by restenosis was reported in 2 arteries (6%).Recurrent stenosis was seen more often in men (р=0.0173). Toconclude, stenting of the extracranial portion of the vertebralartery is safe and clinically effective. Usage of drug-elutingstents cannot help solving the problem of reducing the high riskof restenosis in the late postoperative period.

Keywords

• vertebral artery stenosis
• еndovascular treatment
• drug-eluting stents
• restenosis