Background and purpose High in-stent restenosis (ISR) rates have been reported after treatment of intracranial atherosclerotic stenosis (ICAS). Balloon-mounted drug-eluting stent (DES) implantation has led to an ISR reduction in coronary vessels and may provide a solution to overcome this obstacle in the intracranial circulation. We present our initial experience with the everolimus-eluting stent (EES; Abbott Vascular, Abbott Park, Illinois, USA), a second-generation balloon-mounted DES, for ICAS treatment.
Methods A retrospective review of prospectively collected endovascular data at our institution resulted in the identification of six patients with ICAS treated with EES. Data collected included patient demographics, presentation, comorbidities and lesion, intervention and follow-up details.
Results These six patients had >70% angiographic ICAS and history of stroke or recurrent transient ischemic attacks, despite aspirin therapy and medical management of comorbidities. Lesions were located in the V4-vertebral artery segment (n=2), M1 middle cerebral artery segment (n=1), proximal basilar artery (n=1), supraclinoid internal carotid artery (n=1) and petrous internal carotid artery (n=1). Average stenosis severity was 82.8±6.6% (median, 80%); average lesion length was 10.2±2.2 mm. Stent placement was successful in all cases. Average postintervention stenosis was 5.5±4.4% (median, 7.5%). One patient had postintervention reperfusion hemorrhage that required urgent decompressive craniectomy. None of the five patients with angiographic follow-up (5–6 months) had ISR. The six patients had 4–10 months of clinical follow-up. Only the patient with reperfusion hemorrhage had decreased functional status after treatment (modified Rankin scale score=4) and is making a slow recovery.
Conclusion This study confirms feasibility of use of a second-generation DES for ICAS and provides short-term follow-up results.
- drug-eluting stent
- in-stent restenosis
- intracranial atherosclerotic stenosis
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A portion of this work was present as a poster at the recent International Stroke Conference. (International Stroke Conference 2010, San Antonio, Texas, USA, 24–26 February 2010).
Competing interests Dr Hopkins receives research support from Toshiba; serves as a consultant to Abbott, Boston Scientific, Cordis, Micrus and W. L. Gore; has a financial interest in AccessClosure, Boston Scientific and Micrus; serves as a board member, trustee, or holds an officer position in AccessClosure and Micrus; receives research support from Abbott, Boston Scientific, Cordis, and ev3; consultant to Lumen Biomedical; financial interest in Cordis, serves as the conference director for Nurcon Conferences/Strategic Medical Seminars LLC; receives honoraria from Bard, Boston Scientific, and Cordis, and serves on the Speakers' Bureau for Abbott Vascular. Dr Levy receives research grant support, other research support (devices) and honoraria from Boston Scientific and research support from Micrus Endovascular and ev3; has ownership interests in Intratech Medical Ltd and Mynx/Access Closure; serves as a consultant on the board of Scientific Advisors to Codman Neurovascular; serves as a consultant per project and/or per hour for Micrus Endovascular, ev3 and TheraSyn Sensors, Inc.; and receives fees for carotid stent training from Abbott Vascular and ev3. Dr Levy receives no consulting salary arrangements. All consulting is per project and/or per hour. Dr Ogilvy serves as a consultant to Mizuho America. Dr Natarajan has no disclosure information to report. Dr Siddiqui has received research grants from the University at Buffalo and from the National Institutes of Health (NINDS 1R01NS064592-01A1) is a consultant to Codman Neurovascular, Concentric Medical, ev3 and Micrus Endovascular; serves on speakers' bureaus for Codman Neurovascular and Genentech; and has received honoraria from Genentech, Neocure Group LLC, American Association of Neurological Surgeons' courses and an Emergency Medicine Conference and from Codman Neurovascular for training other neurointerventionists. Dr Siddiqui receives no consulting salary arrangements. All consulting is per project and/or per hour.
Ethics approval This study was conducted with the approval of the University at Buffalo Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Although everolimus-coated stents are approved for use in the coronary circulation as a premarket-approval device, intracranial use is off-label.