Single-center outcomes of Onyx drug-eluting balloon-mounted stents for neurovascular atherosclerotic disease

Abstract

Introduction

Stenting is increasingly used for neurovascular atherosclerotic lesions, but standardized techniques and dedicated devices remain lacking.

Objective

To report outcomes and technical considerations of off-label use of the coronary Onyx drug-eluting stents (DES) for intra- and extracranial neurovascular atherosclerotic lesions.

Methods

We retrospectively reviewed all patients who underwent Onyx DES placement for neurovascular atherosclerotic lesions at our institution between January 2018 and September 2024. Demographics, clinical presentation and follow-up, angiographic findings, procedural details, and complications were collected. Outcomes included procedural success, periprocedural stroke, and in-stent restenosis (ISR) requiring reintervention.

Results

84 Onyx DES were deployed in 63 patients (33% female). Procedural success was achieved in all cases. Stent locations included the basilar artery (21.4%), middle cerebral artery (20%), cervical internal carotid artery (ICA) (2.4%), petrous ICA (4.8%), cavernous ICA (8.3%), supraclinoid ICA (10.7%), V1 (10.7%), V3 (1.2%), and V4 (19%). Three patients (4.8%) developed iatrogenic carotid-cavernous fistulae, all successfully treated. Postprocedural stroke rate was 4.8%. During a mean follow-up of 20.6 months, three patients (4.8%) required angioplasty for ISR. Independent predictors of complications included posterior circulation stenting (OR 13.8, p = .005), smaller stent diameter (OR 0.17, p = .03), and higher stent number (OR 14.7, p < .0001).

Conclusion

Onyx DES demonstrated excellent navigability, high technical success, and favorable long-term outcomes in patients with neurovascular atherosclerotic lesions. Together with growing comparative evidence, these findings suggest newer-generation DES may overcome limitations of earlier stent systems and merit further prospective evaluation.