Endovascular treatment of vertebral artery ostial stenosis with second generation drug-eluting coronary stents: Long-term follow up

Abstract

Background and purpose: To evaluate the patency and clinical outcomes of drug-eluting stents (DES) in patients with symptomatic and significant vertebral artery ostial stenosis (VAOS).

Methods: This single-center, retrospective observational study included 31 patients (21 males, 10 females; mean age: 64 ± 10.56 years) who underwent DES placement for severe (>70 %) symptomatic VAOS in our institution between 2013 and 2023. Patients who had received DES placement for other indications-such as dissection, aneurysm, or intracranial vertebral artery stenosis-were excluded. The primary outcomes were technical success, clinical response, and the incidence of peri‑procedural and post-procedural complications. Data were collected and assessed using the hospital's electronic medical records. Follow-up imaging was primarily performed using Doppler ultrasonography (DUS). In equivocal cases, digital subtraction angiography (DSA) and computed tomography angiography (CTA) were performed. Descriptive statistics were used to summarize the data. Continuous variables are presented as mean ± standard deviation, while categorical variables are expressed as counts and percentages.

Results: Technical success was achieved in all patients (100 %). The mean follow-up duration was 20 ± 4 months. Two patients were lost to follow-up and excluded from follow-up analysis. Although no significant restenosis was detected during follow-up, mild in-stent restenosis (<30 %) was observed in two symptomatic patients (6.9 %), both of whom were successfully treated with medical therapy. Our findings demonstrate favorable short-term neurological improvement in acute stroke cases, along with sustained symptom control during long-term follow-up (93.1 %).

Conclusion: This study supports the long-term efficacy and safety of second-generation DES in treating VAOS. The results are consistent with the Vertebral Artery Ischaemia Stenting Trial (VIST), particularly in demonstrating low complication rates in extracranial vertebral artery stenosis.

Keywords: Drug-eluting stent; Posterior circulation brain infarction; Vertebral artery stenosis.