J Cerebrovasc Endovasc Neurosurg.  2020 Dec;22(4):216-224. 10.7461/jcen.2020.E2020.09.001.

Long-term outcomes of drug-eluting stent implantation in patients with symptomatic extra- and intracranial atherosclerotic stenoses

• Kim J
• Ban SP
• Kim YD
• Kwon OK

• KMID: 2511035
• DOI: http://doi.org/10.7461/jcen.2020.E2020.09.001

Abstract

Objective
Implantation of drug-eluting stents (DES) for extra- and intracranial atherosclerotic stenoses is an emerging topic. It has the potential benefit of preventing recurrent stroke with a reduced rate of in-stent restenosis (ISR).
Methods
Patients who underwent extra- or intracranial stenting using DES in a single institution were retrospectively reviewed with long-term angiographic and clinical follow-up data.
Results
Twenty-one patients, 9 (42.9%) with extracranial lesions and 12 (57.1%) with intracranial lesions, were included. The most common symptom was cerebral infarction (71.4%), followed by vertebrobasilar insufficiency (19.1%) and transient ischemic attack (9.5%). All patients achieved technical success, with the mean degree of stenosis of 85.9±6.3% before the procedure and 19.5±5.9% after the procedure. All patients showed clinical improvement and no symptomatic recurrence was reported during the mean clinical follow-up period of 45.5±8.9 months. The significant ISR was observed in one patient (4.8%) during the mean radiological follow-up period of 42.8±10.0 months.
Conclusions
Implantation of drug-eluting stents for symptomatic extra- and intracranial atherosclerotic stenoses is feasible and has the potential benefit of reducing the rate of ISR.

Keyword

‌Drug-eluting stent; In-stent restenosis; Percutaneous transluminal angioplasty and stenting; Cerebral ischemic disease; Atherosclerosis

Figure

• 

  Fig. 1. A 55-year-old female with symptomatic left paraclinoid internal carotid artery stenosis treated with a 2.25×9 mm Orsiro drug-eluting stent (Patient 11 in Table 1). The diffusion-weighted image shows acute infarction in the left corona radiata (A). Hypoperfusion in the left middle cerebral artery territory was observed in single photon emission computed tomography (SPECT) (B). The degree of stenosis decreased from 90% (C) to 20% (D) on digital subtraction angiography (DSA). On 34-month follow-up, no significant in-stent restenosis was found in DSA (E), and perfusion was improved in SPECT (F).

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