Neurointervention.  2013 Feb;8(1):9-14. 10.5469/neuroint.2013.8.1.9.

Long-term Outcomes of Drug-eluting Stents in Symptomatic Intracranial Stenosis

• Park S
• Lee DG
• Chung WJ
• Lee DH
• Suh DC

• KMID: 2052075
• DOI: http://doi.org/10.5469/neuroint.2013.8.1.9

Abstract

PURPOSE
The use of drug-eluting stent (DES) to treat intracranial stenosis has shown short-term success. However, there are no reports regarding the long-term results of DES. We present the long-term clinical outcome after DES stenting for symptomatic severe intracranial stenosis.
MATERIALS AND METHODS
Our study included a consecutive series of 11 patients who underwent intracranial stenting using DES between March and July, 2006, during the time when bare metal stents were not available at our medical institution. The mean patient age was 59 years. Lesion location was the middle cerebral artery in five patients, the intradural vertebral artery in three, the basilar artery in one, the vertebrobasilar junction in one, and the cavernous internal cerebral artery in one patient. We evaluated the technical success, defined as reduction of residual stenosis < or =30% in the target lesion) as well as the clinical and imaging outcomes as long as 75 months following the procedure. In addition to a cerebral angiogram (n = 2), follow-up study was obtained by CT angiography (n = 6) or intracranial Doppler imaging (n = 2) during a mean time of 55 months after the procedure (range, 24 to 73 months). Three patients refused imaging follow-up and accepted only clinical follow-up. The mean clinical follow-up period was 67 months (range, 47-75 months).
RESULTS
Stenting in all patients was technically successful and without periprocedural complications. There was thrombus formation during the procedure in one patient who experienced no further complications. There were no new neurological events during the mean follow-up period of 5.6 years. No patients were found to have restenosis > or =50% at during the mean follow-up period of 55 months. One patient died of a sudden heart attack 59 months following the procedure which was regarded as unrelated to the cerebral lesion.
CONCLUSION
Our study demonstrates that DES shows long-term stability and safety, and results in good clinical outcomes with a low rate of restenosis.

Keyword

Drug-eluting stents; Intracranial stenosis; Atherosclerosis

MeSH Terms

Angiography
Atherosclerosis
Basilar Artery
Caves
Cerebral Arteries
Constriction, Pathologic
Drug-Eluting Stents
Follow-Up Studies
Heart
Humans
Middle Cerebral Artery
Stents
Thrombosis
Vertebral Artery

Figure

• 

  Fig. 1 A 35-year-old male presented with repeated TIAs against medication for 18 months. (A) The initial angiogram showed severe segmental stenosis of the left M1 and moyamoya-like collaterals around the stenosis. (B) There was an intraluminal filling defect after angioplasty and stenting, probably caused by incomplete antiplatelet medication or antiplatelet resistance. (C) The final angiogram obtained after intravenous antiplatelet agent infusion showed good patency of the M1. Also note the immediate disappearance of the moyamoya-like collaterals after stenting. (D) There was approximately 50% restenosis at the distal in-stent portion of the left M1, as seen on the 13-month follow-up angiogram, although the patient was without any symptoms. Cilostazol was added-added to the medication. (E) The restenosis had disappeared on the angiogram obtained 25 months later. (F) There was no symptom recurrence or new symptoms and no evidence of restenosis on the CT angiography obtained 41 months later. Note the symmetric filling of both MCA branches. (G) The linearly reconstructed stent lumen shows luminal patency. Transcranial Doppler examination at 73 months showed slightly increased but similar peak systolic velocities in both M1s.

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