Abstract 1942: Drug-Eluting Stents for Cerebrovascular Disease: Feasibility, Safety and Intermediate-term Outcomes
Background: Cerebral atherosclerosis poses risk of ischemic stroke by embolic or flow-related mechanism. Patients with cerebral vascular disease who are deemed high risk due to critical stenosis or medication failure may have annual risk of recurrent ischemic event in excess of 40%. Major concern with currently used bare metal stents (BMS) is very high rate of restenosis, reportedly > 30%. We analyzed current literature to assess feasibility, safety and short- and intermediate-term outcomes after DES implantation in cerebral circulation.
Methods: We performed a systematic literature search for reports that evaluated DES in cerebrovascular disease. Data were extracted to analyze baseline characteristics, vessel selection, technical success, and peri-procedure and intermediate-term outcome.
Results: Three studies totaling 88 patients, 94 vessels, and 88 stent placements met the inclusion criteria. Mean age of the patients was 61.5 ± 13.1 years. The success rate for DES delivery was 94% (88/94 vessels). 54 stents were paclitaxel-eluting and 34 were sirolimus-eluting. Peri-procedure complication rate was low with 2 disabling strokes (modified Rankin scale > 2), 1 minor stroke and 2 asymptomatic non-flow limiting dissections. No death or bleeding complications occurred. Stent thrombosis occurred in two cases despite double antiplatelet therapy, accounting for the disabling strokes. At intermediate follow-up (6.5 ± 3.15 months), 4 (5%) cases of restenosis of > 50% vessel diameter were detected, one of which was symptomatic. Major stroke-free survival by Kaplan-Meier analysis was 96% at 9 months.
Conclusion: Elective DES delivery in cerebral circulation is technically feasible with low rate of procedural and intermediate-term major stroke or death in high-risk patients. Prospective studies with long term follow-up are required to assess efficacy of DES compared to BMS.