Restenosis rates following vertebral artery origin stenting: Does stent type make a difference

Objectives: To compare our experience with sirolimusand paclitaxel-eluting stents (drug-eluting stents [DES]) and non-drugeluting stents (NDES) for treatment of vertebral artery (VA) origin stenosis and review the literature. Methods: A retrospective review of our prospectively collected database was performed. Clinical and radiologic follow up was obtained by reviewing office records and radiology. Data collected included demographics, comorbidities, presenting symptoms, stenosis severity, contralateral VA stenosis and/or carotid stenosis, type of stent used, angioplasty before or after stenting, post-treatment residual stenosis, clinical and radiological follow up and retreatment. Patients with symptomatic > 60% stenosis or asymptomatic > 70% stenosis and/or a hypoplastic or occluded contralateral VA or significant carotid occlusion were chosen for revascularization. Results: Thirty-five patients treated with NDES and 15 treated with DES for management of VA origin stenosis were identified. The technical success rate of the procedure was 100%. There were no procedural complications. There were 7 asymptomatic patients (NDES Group-4, DES Group-3). In the NDES Group, 9 patients had prestent angioplasty; 2 had post-stent angioplasty. In the DES group, 4 patients had post-stent angioplasty. Symptoms resolved in 30/31 (96.8%) patients treated with NDES and 11/12 (91.7%) treated with DES. Thirty-six patients had radiologic follow up (median 21.3 months); in-stent restenosis was documented in 11 patients (NDES 9/24 [38%], DES 2/12 [17%]). Among patients receiving NDES, restenotic lesions required angioplasty in 7 patients. No patients in the DES group required angioplasty. Conclusions: DES for treatment of VA origin stenosis may decrease the incidence of restenosis when compared to NDES. Validation in prospective, randomized, multicenter trials is necessary.