Drug-Eluting stents in the treatment of proximal vertebral artery stenosis

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Abstract

The objective of the study was to assess the efficacy of endovascular revascularization with drug-eluting stents in patients with proximal atherosclerotic stenosis of the vertebral arteries. We studied 32 subjects (61±10 years) who underwent 35 interventions of sirolimus- or tacrolimus-coated stent placement (3 patients were operated on both vertebral arteries). Twentyseven (84%) patients were symptomatic. All patients received double antiplatelet therapy after the intervention. The intervention was technically successful in 89% cases. No cases of acute stroke, myocardial infarction or death were seen in the perioperative period. Ultrasound scanning showed that stents remained completely patent. Twenty-nine (91%) subjects with 32 stents were followed-up for a mean period of 9.5 months. No acute strokes in the vertebral basin were reported, although recurrent symptoms were noted in 3 patients. In-stent restenosis was found in 16 (50%) vertebral arteries in 15 patients, and it was asymptomatic in 12 (80%) cases. Restenosis ≥50% (n=13) and re-occlusion (n=3) were seen more often in the tacrolimuseluting stents compared to the sirolimus-eluting stents (10 out of 14 cases [71%] vs. 6 out of 18 cases [33%], р=0.1794). Stent damage followed by restenosis was reported in 2 arteries (6%). Recurrent stenosis was seen more often in men (р=0.0173). To conclude, stenting of the extracranial portion of the vertebral artery is safe and clinically effective. Usage of drug-eluting stents cannot help solving the problem of reducing the high risk of restenosis in the late postoperative period.

About the authors

A. O. Chechetkin

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

S. I. Skrylev

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

A. Yu. Koshcheev

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

V. L. Shchipakin

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

A. V. Krasnikov

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

Z. A. Suslina

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

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Copyright (c) 2017 Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.

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