Long-term outcome of drug-eluting stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium.

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.