Midterm outcomes of paclitaxel-eluting stents for the treatment of intracranial posterior circulation stenoses

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Object

Symptomatic intracranial vertebral and basilar artery atherosclerotic stenoses carry a high risk of stroke and permanent disability if refractory to maximal medical therapy. The authors conducted a study to determine the technical feasibility and midterm clinical and angiographic outcomes in patients in whom paclitaxel-eluting stents were placed for the treatment of symptomatic intracranial posterior circulation stenoses.

Methods

A retrospective review of medical records and imaging studies was performed for 13 consecutive patients in whom paclitaxel-coated stents were used to treat symptomatic posterior circulation intracranial stenoses between 2002 and 2005. Clinical follow-up data were supplemented by telephone interviews.

The technical success rate for stent placement was 100%. One patient (8%) suffered a periprocedural stroke. Twelve patients (92%) underwent clinical follow up for a minimum of 3 months postsurgery, and 11 (92%) of these patients remained asymptomatic after a mean period of 10.9 months. Nine patients (69%) underwent catheter angiographic follow up, and no patient had significant in-stent recurrence of stenosis after a mean period of 5.4 months.

Conclusions

Treatment of intracranial posterior circulation stenoses with drug-eluting stents is technically feasible, and the rate of clinically significant periprocedural complications is low. Rates of stenosis recurrence are reduced compared with those of bare-metal stents in the midterm. Midterm clinical outcome is excellent; no symptom recurrence was observed in this patient cohort.

Abbreviations used in this paper:BA = basilar artery; CT = computed tomography; DES = drug-eluting stent; ISR = in-stent restenosis; VA = vertebral artery; VBA = vertebrobasilar artery.

Article Information

Address reprint requests to: Perry P. Ng, M.D., Department of Radiology, University of Utah Hospital, 30 North, 1900 East, #1A71, Salt Lake City, Utah 84132-2140. email: perry.ng@hsc.utah.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A: Pretreatment digital subtraction angiogram revealing a long-segment irregular stenosis of the intracranial segment of the nondominant left VA. B: The dominant right VA has a pinhole stenosis near the VBA junction, with very poor distal filling of the BA (arrows). C: Oblique projection image obtained after placement of a 2.75 × 12–mm paclitaxel-coated stent, showing minimal residual stenosis.

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