Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study
Restricted accessResearch articleFirst published online October, 2020
Validation and comparison of drug eluting stent to bare metal stent for restenosis rates following vertebral artery ostium stenting: A single-center real-world study
While drug-eluting stents (DES) have been widely applicated in coronary stenosis, uncertainty persists concerning the relative performance and clinical benefit in patients undergoing vertebral artery stenting when compared with a bare metal stent (BMS). We sought to compare in-stent restenosis (ISR) rates of DES and BMS in the treatment of vertebral artery ostium (VAO) stenosis.
Materials and Methods
This study analyzed a single-center prospective cohort. Over 1.5-year period (January 2014-June 2015), 137 consecutive patients underwent VAO stenting involving deployment of 76 DES and 74 BMS. Patient demographics, comorbidities, stenosis severity, stent diameters and lengths, periprocedural complications, imaging and duplex ultrasonography follow-up and recurrent symptoms were assessed.
Results
Technical success was achieved in all patients. Mean VAO stenosis at presentation were 82.4 ± 7.2% in the DES group and 83.3 ± 7.5% in the BMS group and were reduced to 12.5 ± 4.5% and 11.3 ± 4.0%. Mean stent diameter was 3.53 ± 0.40 mm in DES and 5.05 ± 0.40 mm in BMS (p < 0.0001). Mean follow-up was 12.3 months for DES and 11.7 months for BMS. The use of DES was associated with significant lower ISR rates compared with BMS (18.4% vs. 31.1%; OR = 2.628, p = 0.021). Recurrent symptoms rates were similar in DES vs. BMS (2.6% vs 2.7%, p = 0.680). Stent type and stent diameter were independent risk factors for ISR (P = 0.026).
Conclusion
Our results suggest superior efficacy of deploying DES for the treatment of VAO stenosis with lower ISR rates as compared to BMS, but do not support significant differences in periprocedural risk and recurrent symptoms rate.
EdgellRCZaidatOOGuptaR, et al.
Multicenter study of safety in stenting for symptomatic vertebral artery origin stenosis: results from the society of vascular and interventional neurology research consortium. J Neuroimaging2013;
23: 170–174.
2.
JenkinsJSPatelSNWhiteCJ, et al.
Endovascular stenting for vertebral artery stenosis. J Am Coll Cardiol2010;
55: 538–542.
3.
ChenWHuangFLiM, et al.
Incidence and predictors of the in-stent restenosis after vertebral artery ostium stenting. J Stroke Cerebrovasc Dis2018;
27: 3030–3035.
4.
AkinsPTKerberCWPakbazRS.Stenting of vertebral artery origin atherosclerosis in high-risk patients: bare or coated? A single-center consecutive case series. J Invasive Cardiol2008;
20: 14–20.
5.
ZaytsevAYStoydaAYSmirnovVE, et al.
Endovascular treatment of supra-aortic extracranial stenoses in patients with vertebrobasilar insufficiency symptoms. Cardiovasc Intervent Radiol2006;
29: 731–738.
6.
SSYLVIA Study Investigators.Stenting of symptomatic atherosclerotic lesions in the vertebral or intracranial arteries (SSYLVIA): study results. Stroke2004;
35: 1388–1392.
7.
KizilkilicOOguzkurtLYildirimT, et al.
Endovascular treatment of vertebral artery origin stenosis in high risk patients. Tani Girisim Radyol2004;
10: 252–258.
8.
Al-LameeRIelasiALatibA, et al.
Comparison of long-term clinical and angiographic outcomes following implantation of bare metal stents and drug-eluting stents in aorto-ostial lesions. Am J Cardiol2011;
108: 1055–1060.
9.
KoYGParkSKimJY, et al.
Percutaneous interventional treatment of extracranial vertebral artery stenosis with coronary stents. Yonsei Med J2004;
45: 629–634.
10.
TankVHGhoshRGuptaV, et al.
Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis. J Neurointerv Surg2016;
8: 770–774.
11.
LangwieserNBuyerDSchusterT, et al.
Bare metal vs. drug-eluting stents for extracranial vertebral artery disease: a meta-analysis of nonrandomized comparative studies. J Endovasc Ther2014;
21: 683–692.
12.
JiaLHuaYLiJ, et al.
Optimal ultrasound criteria for defining the severity of vertebral artery in-stent restenosis. Ultrasound Med Biol2015;
41: 775–780.
13.
CompterAvan der WorpHBSchonewilleWJ, et al.; VAST Investigators.
Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurol2015;
14: 606–614.
14.
KocakBKorkmazerBIslakC, et al.
Endovascular treatment of extracranial vertebral artery stenosis. World J Radiol2012;
4: 391–400.
15.
JiangYXuXWenZ, et al.
In-stent restenosis after vertebral artery stenting. Int J Cardiol2015;
187: 430–433.
16.
EberhardtONaegeleTRaygrotzkiS, et al.
Stenting of vertebrobasilar arteries in symptomatic atherosclerotic disease and acute occlusion: case series and review of the literature. J Vasc Surg2006;
43: 1145–1154.
17.
LangwieserNProthmannSBuyerD, et al.
Safety and efficacy of different stent types for the endovascular therapy of extracranial vertebral artery disease. Clin Res Cardiol2014;
103: 353–362.
18.
LiJHuaYNeedlemanL, et al.
Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting. J Neurointerv Surg2019;
11: 574–578.
19.
LiMKATsangACOTsangFCP, et al.
Long-term risk of in-Stent restenosis and stent fracture for extracranial vertebral artery stenting. Clin Neuroradiol2019;
29: 701–706.
20.
ZhouZYinQXuG, et al.
Influence of vessel size and tortuosity on in-stent restenosis after stent implantation in the vertebral artery ostium. Cardiovasc Intervent Radiol2011;
34: 481–487.
21.
LedermanRJMendelsohnFOSantosR, et al.
Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J2001;
142: 314–323.
22.
JensenLOVikmanSAntonsenL, et al.
Intravascular ultrasound assessment of minimum lumen area and intimal hyperplasia in in-stent restenosis after drug-eluting or bare-metal stent implantation. The Nordic intravascular ultrasound study (NIVUS). Cardiovasc Revasc Med2017;
18: 577–582.
23.
KangSJMintzGSParkDW, et al.
Mechanisms of in-stent restenosis after drug-eluting stent implantation: intravascular ultrasound analysis. Circ Cardiovasc Interv2011;
4: 9–14.
24.
WesselyRSchomigAKastratiA.Sirolimus and paclitaxel on polymer-based drug-eluting stents: similar but different. J Am Coll Cardiol2006;
47: 708–714.
25.
ChenXHuangQHongB, et al.
Drug-eluting stent for the treatment of symptomatic vertebral origin stenosis: long-term results. J Clin Neurosci2011;
18: 47–51.
26.
ParkMSFiorellaDStiefelMF, et al.
Vertebral artery origin stents revisited: improved results with paclitaxel-eluting stents. Neurosurgery2010;
67: 41–48; discussion 8.
27.
GuptaRAl-AliFThomasAJ, et al.
Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke2006;
37: 2562–2566.
28.
VajdaZMiloslavskiEGutheT, et al.
Treatment of stenoses of vertebral artery origin using short drug-eluting coronary stents: improved follow-up results. AJNR Am J Neuroradiol2009;
30: 1653–1656.
29.
OgilvyCSYangXNatarajanSK, et al.
Restenosis rates following vertebral artery origin stenting: does stent type make a difference?J Invasive Cardiol2010;
22: 119–124.
30.
StaymanANNogueiraRGGuptaR.A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke2011;
42: 2212–2216.
31.
LuHZhengPZhangW.Long-term outcome of drug-eluting stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium. J Neurointerv Surg2013;
5: 435–439.
32.
LugmayrHKastnerMFrohlerW, et al.
Sirolimus-eluting stents for the treatment of symptomatic extracranial vertebral artery stenoses: early experience and 6-month follow-up. Rofo2004;
176: 1431–1435.
33.
RaghuramKSeynnaeveCRaiAT.Endovascular treatment of extracranial atherosclerotic disease involving the vertebral artery origins: a comparison of drug-eluting and bare-metal stents. J NeuroIntervent Surg2012;
4: 206–210.
34.
BhatiaVBhatiaRDhindsaM.Drug-eluting stents: new era and new concerns. Postgrad Med J2004;
80: 13–18.
35.
ErtaşGvan BeusekomHMvan der GiessenWJ.Late stent thrombosis, endothelialisation and drug-eluting stents. Neth Heart J2009;
17: 177–180.
36.
NakanoMVirmaniR.Histopathology of vascular response to drug-eluting stents: an insight from human autopsy into daily practice. Cardiovasc Interv Ther2015;
30: 1–11.
37.
MadyckiGGabrielMHawroP, et al.
Duplex Doppler ultrasound examination of carotid and vertebral arteries: guidelines of the polish society for vascular surgery. Kardiol Pol2014;
72: 288–309.
38.
ŠkodaOKalvachPProcházkaB, et al.
Non-invasive evaluation of proximal vertebral artery stenosis using color Doppler sonography and CT angiography. J Neuroradiol2014;
41: 336–341.
