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


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Abstract

The objective of the study was to evaluate the efficacy of endovascular revascularization treatment using drug-eluting stents in patients with atherosclerotic proximal vertebral artery (VA) stenosis. Thirty-two patients (61 ± 10 years old) were implanted with 35 sirolimus and tacrolimus eluting stents (3 patients had them from two sides). 27 patients (84%) had vertebrobasilar symptoms at enrollment. All patients were pretreated with dual antiplatelet therapy. The intervention was technically successful in 89% cases. No stroke, myocardial infarction, or death occurred in perioperative period. On duplex scanning the stents remained completely functional. In the late postoperative period 29 (91%) patients, with 32 implanted stents were followed- up. The mean follow-up was 9.5 months. No stroke occurred in patients during this period. Recurrence of vertebrobasilar insufficiency symptoms was noted in 3 patients. VA renarrowing was detected in 16 (50%) arteries in 15 patients, and 12 (80%) of them were asymptomatic. Restenosis ≥50% (n = 13) and reocclusion (n = 3) were more frequent in those with implantation of tacrolimus eluting stents compared to those with sirolimus eluting stents: 10 (71%) of 14 observations to 6 (33%) of 18 cases (p = 0.1794), respectively. Stent fracture was observed in 2 cases (6%), followed by restenosis. Restenosis rate prevailed in men (p = 0.0173). Thus, stenting of VA extracranial portion is reasonably safe procedure with a good clinical effect. The use of drug-eluting stents looks promising but does not solve the problem of high restenosis rate in the late postoperative period.

About the authors

A. O. Chechetkin

Research Center of Neurology

Author for correspondence.
Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367

S. I. Skrylev

Research Center of Neurology

Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367

A. Yu. Koshcheev

Research Center of Neurology

Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367

V. L. Shchipakin

Research Center of Neurology

Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367

A. V. Krasnikov

Research Center of Neurology

Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367

Z. A. Suslina

Research Center of Neurology

Email: andreychechetkin@gmail.com
Russian Federation, Moscow, 125367


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