Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting

A Meta-Analysis of Drug Eluting Stents vs. Bare Metal Stents for Treatment of Extracranial Vertebral Artery Disease Background: —Although a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared to bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial. Methods: —A search strategy was used using the terms "stents," "drug-eluting stents," "atherosclerosis," "vertebral artery," and "vertebrobasilar insufficiency" through Medline. Five studies met the criteria for a comparative meta-analysis. The technical and clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis and recurrent symptoms and overall survival were compared between the DES and BMS groups using the Mantel-Haenszel method with fixed and random effect models. Results: —The mean pretreatment stenosis was 83.8±4.2% in the DES group (n = 156) and 80.12±2.7% in the BMS group (n = 148). There was no significant difference in the technical success (OR = 1.528, p = 0.622), clinical success (OR = 1.917, p = 0.274) and periprocedural complications (OR = 0.741, p = 0.614) between the two groups. The rates of technical success, clinical success and periprocedural complications were 98.78%, 95.77% and 1.94% for the DES group vs. 100%, 97.96% and 2.96% for the BMS group. There was no periprocedural mortality, stroke or TIA. The mean clinical and radiological follow-up times were 19.1±6.9 and 14.23±1.5 months respectively, for the DES arm and 26±7.6 and 20.5±3.3 months, respectively, for the BMS group. A 0.388 odds ratio of no-restenosis in the BMS to DES arms (p = 0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs. 15.49%, respectively). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs. 11.26%; OR = 3.319, p = 0.011) and TVR (4.83% vs. 19.21%; OR = 4.099, p = 0.001). There was no significant difference between overall survival (OR = 0.655, p = 0.32). Conclusion: —A lower rate of restenosis, recurrent symptoms and target vessel revascularization was noted in the DES group.

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Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011697 ◽

2015 ◽

Vol 8 (8) ◽

pp. 770-774 ◽

Cited By ~ 11

Author(s):

Vivek H Tank ◽

Ritam Ghosh ◽

Vikas Gupta ◽

Nakul Sheth ◽

Shariyah Gordon ◽

...

Keyword(s):

Vertebral Artery ◽

Clinical Success ◽

Meta Analysis ◽

Bare Metal Stents ◽

Drug Eluting Stents ◽

Metal Stents ◽

Vertebrobasilar Insufficiency ◽

Bare Metal ◽

Drug Eluting ◽

Extracranial Vertebral Artery

BackgroundWhile a growing number of reports offer evidence for the potential of drug eluting stents (DES) in treating atherosclerotic stenosis of the extracranial vertebral artery, their efficacy when compared with bare metal stents (BMS) is uncertain due to the lack of a large prospective randomized trial.MethodsA search strategy using the terms ‘stents’, ‘drug-eluting stents’, ‘atherosclerosis’, ‘vertebral artery’, and ‘vertebrobasilar insufficiency’ was employed through Medline. Five studies met the criteria for a comparative meta-analysis. The technical/clinical success, periprocedural complications, target vessel revascularization (TVR), rates of restenosis, recurrent symptoms, and overall survival were compared.ResultsThere was no significant difference in the technical success (OR=1.528, p=0.622), clinical success (OR=1.917, p=0.274), and periprocedural complications (OR=0.741, p=0.614) between the two groups. An OR of 0.388 for no restenosis in the BMS to DES arms (p=0.001) indicated a significantly higher restenosis rate in the BMS group relative to the DES group (33.57% vs 15.49%). When compared with the DES group, the BMS group had a significantly higher rate of recurrent symptoms (2.76% vs 11.26%; OR=3.319, p=0.011) and TVR (4.83% vs 19.21%; OR=4.099, p=0.001).ConclusionsA significantly lower rate of restenosis, recurrent symptoms, and TVR was noted in the DES group compared with the BMS group.

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Drug-Eluting vs. Bare Metal Stents for Symptomatic Vertebral Artery Stenosis

Journal of Endovascular Therapy ◽

10.1583/11-3718.1 ◽

2012 ◽

Vol 19 (2) ◽

pp. 231-238 ◽

Cited By ~ 21

Author(s):

Lipo Song ◽

Jianxin Li ◽

Yongquan Gu ◽

Hengxi Yu ◽

Bing Chen ◽

...

Keyword(s):

Vertebral Artery ◽

Bare Metal Stents ◽

Artery Stenosis ◽

Metal Stents ◽

Bare Metal ◽

Vertebral Artery Stenosis ◽

Drug Eluting

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Endovascular treatment of extracranial atherosclerotic disease involving the vertebral artery origins: a comparison of drug-eluting and bare-metal stents

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2011-010051 ◽

2011 ◽

Vol 4 (3) ◽

pp. 206-210 ◽

Cited By ~ 14

Author(s):

Karthikram Raghuram ◽

Carl Seynnaeve ◽

Ansaar T Rai

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Bare Metal Stents ◽

Atherosclerotic Disease ◽

Metal Stents ◽

Bare Metal ◽

Drug Eluting

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Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014243 ◽

2018 ◽

Vol 11 (6) ◽

pp. 574-578 ◽

Cited By ~ 2

Author(s):

Jingzhi Li ◽

Yang Hua ◽

Laurence Needleman ◽

Flemming Forsberg ◽

John R Eisenbray ◽

...

Keyword(s):

Regression Analysis ◽

Vertebral Artery ◽

Cox Regression ◽

Bare Metal Stents ◽

Metal Stents ◽

Bare Metal ◽

Cox Regression Analysis ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

ObjectiveThe study was designed to investigate if vascular occlusion in the internal carotid artery (ICA) or the contralateral vertebral artery (VA) contribute to developing in-stent restenosis (ISR) in patients with vertebral artery ostium stenosis (VAOS).Methods420 consecutive patients treated with VAOS stents (from a population of 8145 patients with VAOS) from January 2013 to December 2014 were analyzed in this retrospective study; 216 with drug eluted stents and 204 with bare metal stents. Based on pre-stent DSA findings, patients were divided into four groups: both carotid and vertebral arteries patent (PAT), ICA occlusion (ICA-OCC), contralateral VA occlusion (CVA-OCC), and combined occlusions (C-OCC). The incidence of ISR (stenosis >50%) was compared between groups using Cox regression analysis.ResultsOf the 420 patients, the mean incidence of ISR was 36.4%, with a median 12 months of follow-up (IQR 3–12). Logistic regression analysis showed that drug eluting stent had less ISR than bare metal stent (OR=0.38, 95% CI 0.19 to 0.75, P=0.01). Cox regression analysis showed that CVA-OCC (HR=1.63, P=0.02) and C-OCC (HR=3.30, P=0.001) were risk factors for ISR but not ICA-OCC (P=0.31). In the CVA-OCC and C-OCC groups, in-stent peak systolic velocity (PSV) ≥140 cm/s, 1 day after successful stenting, was associated with subsequent development of ISR (OR=2.81, 95% CI 1.06 to 7.43, P=0.04).ConclusionContralateral VA occlusion at the time of stenting increased the risk of ISR, especially if stent PSV on day 1 was >140 cm/s. Bare metal stents had more ISR than drug eluting stents.

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