Safety and efficacy of different stent types for the endovascular therapy of extracranial vertebral artery disease

Abstract

This study aims to determine safety and efficacy of different stent types for extracranial vertebral artery stenting (EVAS) at a single-center institution. Although endovascular revascularization techniques are well established for a variety of arterial vessel territories, its role within the vertebrobasilar system is less well defined. We retrospectively analyzed all EVAS procedures performed at our institution between 1997 and 2012. A total of 35 EVAS procedures were attempted in 35 patients with symptomatic occlusive extracranial vertebral artery (EVA) disease. Carotid self-expanding bare-metal stents (BMS-SE; n = 18), coronary balloon-expandable bare-metal stents (BMS-BE; n = 7) or drug-eluting stents (DES-BE; n = 16) were used according to physician's choice. The overall technical and clinical success rate was 100 and 94 %, respectively. Periprocedural complications included one death 14 days after intervention due to complications of initial stroke and 3 (9 %) patients with access site complications. Follow-up after a median of 18 ± 21 months yielded an overall in-stent restenosis rate of 23 % and a recurring clinical symptoms rate of 20 % whereas both endpoints were closely associated as 83 % of patients with recurring symptoms showed significant restenosis. Concerning the stent type, BMS-SE were associated with a significant higher in-stent restenosis rate compared to balloon-expandable stents (p = 0.012), and although not statistically significant, there was a clear trend towards a lower in-stent restenosis rate in drug-eluting compared to bare-metal stents (p = 0.068). In patients with symptomatic extracranial vertebral artery disease, stenting is a safe and effective treatment option whereas balloon-expandable stents, and particularly drug-eluting stents, are superior to self-expanding stents.