Abstract WMP44: A Meta-Analysis of Drug Eluting Stents vs Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease

Abstract

A Meta-Analysis of Drug Eluting Stents vs. Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease Background: —Although a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared to bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial. Methods: —A search strategy was used using the terms "stents," "drug-eluting stents," "atherosclerosis," "vertebral artery," and "vertebrobasilar insufficiency" through Medline. Five studies met the criteria for a comparative meta-analysis. The technical and clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis and recurrent symptoms and overall survival were compared between the DES and BMS groups using the Mantel-Haenszel method with fixed and random effect models. Results: —The mean pretreatment stenosis was 83.8±4.2% in the DES group (n = 156) and 80.12±2.7% in the BMS group (n = 148). There was no significant difference in the technical success (OR = 1.528, p = 0.622), clinical success (OR = 1.917, p = 0.274) and periprocedural complications (OR = 0.741, p = 0.614) between the two groups. The rates of technical success, clinical success and periprocedural complications were 98.78%, 95.77% and 1.94% for the DES group vs. 100%, 97.96% and 2.96% for the BMS group. There was no periprocedural mortality, stroke or TIA. The mean clinical and radiological follow-up times were 19.1±6.9 and 14.23±1.5 months respectively, for the DES arm and 26±7.6 and 20.5±3.3 months, respectively, for the BMS group. A 0.388 odds ratio of no-restenosis in the BMS to DES arms (p = 0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs. 15.49%, respectively). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs. 11.26%; OR = 3.319, p = 0.011) and TVR (4.83% vs. 19.21%; OR = 4.099, p = 0.001). There was no significant difference between overall survival (OR = 0.655, p = 0.32). Conclusion: —A lower rate of restenosis, recurrent symptoms and target vessel revascularization was noted in the DES group.