Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation.
OBJECTIVE
The use of bare metal stents to treat symptomatic intracranial stenosis may be associated with significant restenosis rates. The advent of drug-eluting stents (DESs) in the coronary circulation has resulted in a reduction of restenosis rates. We report our technical success rate and short-term restenosis rates after stenting with DESs in the intracranial and extracranial circulation.


METHODS
This study was a retrospective review of the period between April 1, 2004, and April 15, 2006, of 59 patients with 62 symptomatic intracranial or extracranial atherosclerotic lesions at 2 medical centers (University of Pittsburgh and Borgess Medical Center).


RESULTS
The mean age of our cohort was 61+/-12 years. The location of the 62 lesions was as follows: extracranial vertebral artery 31 (50%), intracranial vertebral artery or basilar artery 18 (29%), extracranial internal carotid artery (ICA) near the petrous bone 5 (8%), and intracranial ICA 8 (13%). There were 2 (3%) periprocedural complications: 1 non-flow-limiting dissection and 1 disabling stroke. Fifty vessels were available for follow-up angiography or computed tomography angiography at a median time of 4.0+/-2 months. A total of 2 of 36 extracranial stents (7%) and 1 of 26 intracranial stents (5%) were found to have restenosis > or = 50% at follow-up.


CONCLUSIONS
This report demonstrates that DES delivery in the intracranial and extracranial circulation is technically feasible. A small percentage of patients developed short-term in-stent restenosis. Longer-term follow-up is required in the setting of a prospective study to determine the late restenosis rates for DESs in comparison with bare metal stents.
Gupta
Rishi
R
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Al-Ali
Firas
F
Thomas
Ajith J
AJ
Horowitz
Michael B
MB
Barrow
Thomas
T
Vora
Nirav A
NA
Uchino
Ken
K
Hammer
Maxim D
MD
Wechsler
Lawerence R
LR
Jovin
Tudor G
TG
D000784:Aortic Dissection / Q000209:etiology; D000925:Anticoagulants / Q000627:therapeutic use; D002114:Calcinosis / Q000628:therapy; D002342:Carotid Artery, External; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000517:prevention & control / Q000628:therapy*; D002404:Catheterization; D015331:Cohort Studies; D004341:Drug Evaluation; D004343:Drug Implants; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009928:Organ Specificity; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D020521:Stroke / Q000209:etiology; D014715:Vertebrobasilar Insufficiency / Q000517:prevention & control / Q000628:therapy*
D000925:Anticoagulants; D004343:Drug Implants; D017239:Paclitaxel; D020123:Sirolimus