ArticleFrontiers in neurology
Endovascular treatment of in-stent restenosis after vertebral artery ostial stenting: incidence, risks and outcomes.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: In-stent restenosis (ISRS) is a major concern following vertebral artery (VA) ostial stenting, potentially leading to recurrent symptoms or ischemic strokes. Despite the growing use of endovascular treatment for VA ostial stenosis (VAOS), data on efficacy and safety of the endovascular re-treatment for ISRS is sparse. Aim of study: To evaluate the incidence of ISRS after VA ostial stenting and assess the safety and effectiveness of endovascular re-interventions. Methods: This single-center retrospective analysis included patients who underwent re-treatment for ISRS >50% using either balloon angioplasty with a drug-coated balloon (DCB), or re-stenting with drug-eluting balloon-mounted stents (DES). The angiographic follow-up was performed in all cases following re-treatment. Periprocedural neurological events, need for re-treatment, and follow-up outcomes were systematically evaluated. Results: Over a mean follow-up period of 56 months (range: 9-183 months) after 564 stenting procedures for VAOS in 525 patients, ISRS >50% was found in 89 stents (15.8%), with the majority (70 out of 89) diagnosed within the first year, at a median time of 7 months (range: 1-147 months). Re-treatment was performed in 88 cases, with DES used in 43.2% and DCB in 56.8%. No periprocedural strokes were observed. Recurrent ISRS was detected in 19 stents (21.6%) at a mean of 23.2 months (range: 4-117 months) following re-treatment. Tobacco use and dyslipidemia were significantly associated with the development of ISRS and its recurrence. Conclusion: The observed ISRS rate underscores the importance of rigorous follow-up after VA ostial stenting. Endovascular re-treatment of high-grade ISRS with DES or DCB appears to be safe and effective, while risk factor management, including smoking cessation, may further reduce recurrence rates.
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