Abstract and Introduction
Abstract
Object Patients with symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (VBA) have a poor prognosis, and those with coexistent intracranial and extracranial stenoses have worse outcomes despite medical therapy. A study was undertaken to investigate the long-term outcome and restenosis rates of patients with symptomatic atherosclerotic stenoses at the intracranial VBA and the vertebral artery ostium (VAO) after drug-eluting stent (DES) placement.
Methods From July 2004 to July 2008, 24 consecutive patients (mean age 65 years) with this condition underwent DES placement. Technical success was defined as stent placement of both the VAO and intracranial VBA stenoses with complete stent coverage of the lesions and residual stenosis of ≤30%. The study end point was a composite of stroke or death within 30 days and ischemic stroke in the VBA territory after 30 days.
Results Technical success was obtained in all patients without any stroke or death within 30 days. During a median follow-up duration of 35 months, recurrent in-stent restenosis developed in two cases (10%) at 12-month follow-up. These two patients were free from stroke recurrence. Thus, the annual stroke rate in the VBA territory (including any stroke or death within 30 days) was 0.
Conclusions This pilot study confirms that DES placement for patients with symptomatic atherosclerotic stenoses at the intracranial VBA and VAO has an acceptable long-term outcome and may be considered as an alternative to medical therapy.
Introduction
Patients with symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (VBA) have a poor prognosis, and those with coexistent intracranial and extracranial stenoses have worse outcomes despite medical therapy. Although medical therapy has been used as the first treatment, its stroke and death rates are notable. Retrospective data suggest that the annual stroke rates for patients with symptomatic intracranial basilar or vertebral artery (VA) stenosis are 10.7% and 7.8%, respectively, despite anticoagulation or antiplatelet therapy.
In recent years, stent implantation has been widely employed in the treatment of VA ostium (VAO) stenosis. However, the long-term outcome of stent placement is affected by in-stent restenosis. Recently, a major concern with the use of bare metal stents for symptomatic stenosis has been the rate of restenosis, reported to be as high as 32%. The recent advent of drug-eluting stents (DESs) in the coronary circulation has significantly reduced the rates of restenosis from about 30% to 4–8% at 9-month follow-up. Nevertheless, whether they work in symptomatic lesions in the intracranial VBA and VAO as well is yet to be determined.
The primary purpose of this study was to investigate the long-term outcome of patients with posterior circulation stenoses after DES placement.