Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: Long-term results

Atherosclerotic stenosis originating from the vertebral artery (VA) is a well-known cause of stroke in the posterior circulation. Stent-assisted angioplasty using a bare metal stent is safe but used in a limited number of patients due to high rates of in-stent restenosis (ISR). A drug-eluting stent (DES) is an alternative for reducing ISR after stenting for atherosclerotic stenosis. We report the technical feasibility and mid to long-term clinical and angiographic outcomes after stenting with a DES in vertebral origin stenosis. This retrospective study included 47 consecutive patients treated with DES for vertebral origin stenosis. The demographics, indications for treatment, procedural technique, clinical and radiographical follow-up results were reviewed. The technical success rate was 100% without any complications. Postprocedure residual stenosis was 8.6% (range = 0-12%). All patients were followed up clinically for a mean of 28.3 months (range = 12-68 months), and two patients (4.2%) had recurrent stroke in stented-vessel territories at 5 and 17 months after the procedure, respectively. Digital subtraction angiography was performed at follow-up in 38 patients (80.9%) at a mean of 16.3 months (range = 6-48 months) and showed two patients with ISR (5.3%) and four stent fractures (10.5%). One asymptomatic ISR was related to stent fracture. DES for vertebral origin stenosis are safe and effective with an acceptable lower ISR rate. However, stent fracture may be a potential complication and requires long-term follow-up.