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Drug eluting stents versus bare metal stents for the treatment of extracranial vertebral artery disease: a meta-analysis
  1. Vivek H Tank1,
  2. Ritam Ghosh2,
  3. Vikas Gupta3,
  4. Nakul Sheth2,
  5. Shariyah Gordon2,
  6. Wenzhuan He2,
  7. Steven F Modica2,
  8. Charles J Prestigiacomo2,
  9. Chirag D Gandhi2
  1. 1Texas Institute for Neurological Disorders (TIND), Sherman, Texas, USA
  2. 2Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  3. 3Department of Neurology, University of Missouri, Columbia, Missouri, USA
  1. Correspondence to Dr Vivek H Tank, Texas Institute for Neurological Disorders, 321 North Highland Avenue, Suite 200, Sherman, TX 75092, USA; vtank{at}texomaneurology.com

Abstract

Background While 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.

Methods A 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.

Results 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. 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).

Conclusions A significantly lower rate of restenosis, recurrent symptoms, and TVR was noted in the DES group compared with the BMS group.

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