Abstract and Introduction
Abstract
Objective To determine whether drug-eluting (DE) stents offer any advantage over bare-metal (BM) stents in terms of restenosis rates and to identify indications for vertebral artery stenting (VAS) based on the current literature.
Methodology A retrospective analysis was performed for patients who underwent extracranial VAS for symptomatic stenosis. Patients were divided into two groups based on stent use (DE and BM).
Results A total of 28 stents were implanted in 24 patients. Of these, 13 were DE and 15 BM. Technical success was achieved in all patients. There were procedure-related complications of retroperitoneal hematoma in some patients (3.6%). The median clinical and imaging follow-up times were 26 and 21 months, respectively, for the BM arm and 13 and 12 months, respectively, for the DE group. The mean stenosis percentage was 80.7±10.9 for the BM group and 87.0±9.5 for the DE group. The mean stent diameter was 4.7±0.5 for the BM group and 3.3±0.4 for the DE group (p<0.0001). There was no statistical difference in the restenosis rates among the two groups, 4/15 (26.7%) for BM and 4/13 (30.8%) for DE stents.
Conclusions Extracranial VAS is a relatively safe procedure. No differences could be elicited in the restenosis rates between BM and DE stents. While VAS has been reported for symptomatic and asymptomatic disease, a benefit of VAS has only been demonstrated for patients with symptoms clearly attributable to the diseased artery. The benefit of stenting in asymptomatic disease or stenting to improve perfusion to the anterior circulation is speculative.
Introduction
Endovascular treatment for extracranial vertebral artery stenosis is not novel. Stenting of vertebral artery origin disease has been performed for symptomatic and asymptomatic disease. With the advent of drug-eluting stents (DES) for treatment of coronary vascular disease it was inevitable that this technology would also be applied to cerebral circulation. There have been reports of use of DES for treating vertebral origin disease with some evidence of reduced restenosis rates, but no large series have demonstrated a clear advantage over bare-metal stents. Further, the need for long-term dual antiplatelet treatment associated with the use of DES in vertebral arteries has not been investigated. The indications of vertebral artery stenting (VAS) also continue to evolve. Our goal was primarily to determine whether DES offered a clear advantage over bare-metal stents in the treatment of extracranial vertebral disease and secondarily to identify indications for VAS that are supported by evidence.