Vertebral Artery Origin Stents Revisited

Abstract

Vertebral origin angioplasty and stenting (VOAS) with bare metal stents is associated with a high rate of in-stent restenosis (ISR). We evaluated the rate of ISR after VOAS with drug-eluting stents. Twenty patients (15 men, 5 women; age range, 36-88 years; mean, 63.7 years) were treated for VOAS with a paclitaxel-eluting stent (Taxus Express2, Boston Scientific, Natick, Massachusetts). Stenosis at follow-up was quantified as insignificant (0%-24%), mild (25%-49%), moderate (50%-74%), and severe (75%-100%). ISR was defined using a binary criteria of >50% stenosis at follow-up angiography. All procedures were technically successful with no periprocedural complications. Follow-up angiography (range, 4-48 months; mean, 14.7 months) showed insignificant stenosis in 9 patients, mild in 6, moderate in 4, and severe in 1. In 1 patient with "moderate" stenosis, the stent migrated distally; therefore, the lesion restenosis was not within the stent. Thus, 4 of 19 patients (21%) exhibited binary moderate or severe ISR, and 5 of 20 showed restenosis at the lesion (25%). The patient with severe stenosis developed stent thrombosis>3 years after VOAS. VOAS with drug-eluting stents was associated with a low incidence of periprocedural complications. Although the rate of restenosis was half that seen with the use of bare metallic stents, 21% of patients still developed moderate or severe ISR. These patients may require>or=1 revascularization procedures. The risk of delayed stent thrombosis may necessitate lifelong dual antiplatelet medications.