Long-term outcomes of drug-eluting stent implantation in patients with symptomatic extra- and intracranial atherosclerotic stenoses

Abstract

Implantation of drug-eluting stents (DES) for extra-and intracranial atherosclerotic stenoses is an emerging topic. It has the potential benefit of preventing recurrent stroke with a reduced rate of in-stent restenosis (ISR). Methods: Patients who underwent extra-or intracranial stenting using DES in a single institution were retrospectively reviewed with long-term angiographic and clinical follow-up data. Results: Twenty-one patients, 9 (42.9%) with extracranial lesions and 12 (57.1%) with intra cranial lesions, were included. The most common symptom was cerebral infarction (71.4%), followed by vertebrobasilar insufficiency (19.1%) and transient ischemic attack (9.5%). All patients achieved technical success, with the mean degree of stenosis of 85.9±6.3% before the procedure and 19.5±5.9% after the procedure. All patients showed clinical improvement and no symptomatic recurrence was reported during the mean clinical follow-up period of 45.5±8.9 months. The significant ISR was observed in one patient (4.8%) during the mean radiological follow-up period of 42.8±10.0 months. Conclusions: Implantation of drug-eluting stents for symptomatic extra-and intracranial atherosclerotic stenoses is feasible and has the potential benefit of re ducing the rate of ISR.

Neurotoxicity of Paclitaxel and Rapamycin in a Rat Model with Transient Blood-Brain Barrier Opening

“…Fortunately, chronic exposure of the brain to low doses of the drugs released from DEBs and DESs appears safe, based on the lack of reports about neurotoxicity due to systemic effects of the drugs in interventional cardiology over 15 years. And, not a few preliminary preclinical and clinical studies showed no local and systemic complications, yet [ 1 , 6 , 7 , 9 , 10 , 12 , 13 , 16 ]. In the early period after DES and DEB placement, high amounts of the drugs are released from the devices within the cerebral arteries.…”

“…4 and Supplementary Figs. [3][4][5][6][7][8][9][10][11][12][13][14]. Moderate degrees of inflammatory cell aggregation and neuronal damage were identified in 1 of 15 sections of just one rat brain (No.…”

“…Regarding the issue of high restenosis rates after cerebral arterial stenting, a proper solution has not yet been identified. Drug-eluting stents (DESs) and drug-eluting balloons (DEBs) in the coronary system, which release drugs that inhibit intimal hyperplasia, have also been used for ICAS with good preliminary results in reducing restenosis [ 1 , 2 , 6 , 7 , 9 , 10 , 12 , 13 , 16 ]. However, applying these drugs to cerebral arteries may provoke neurotoxicity [ 2 , 5 , 12 ].…”

Update on Clinical Management with Neurovascular Stents

“…This success with drug-eluting stents has since been demonstrated in intracranial arteriosclerotic lesions. In 2020, Kim et al demonstrated successful drug-eluting stent placement in 12 patients with intracranial arteriosclerotic stenosis, none of which experienced restenosis in a follow-up period of approximately 43 months [ 64 ]. A 2019 meta-analysis examined restenosis rates in 336 intracranial arteriosclerotic stenosis patients who received drug-eluting stents, reporting a restenosis rate of only 4.1% [ 65 ].…”

Thirty-Day Outcomes of Resolute Onyx Stent for Symptomatic Intracranial Stenosis: A Multicenter Propensity Score–Matched Comparison With Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Trial

“…14 The quest for a new, safe, and less technically challenging device, which will be effective in reducing risk of recurrent stroke beyond 30 days, has recently gained ground with the advent of newer-generation balloon-mounted drug-eluting stent technology. [15][16][17][18] Resolute Onyx zotarolimus-eluting coronary stent (RO-ZES) is favored by some operators because of its unique technical advantages. 16,17,19 In this study, RO-ZES data from 8 high-volume neuroendovascular centers has been combined for the purposes of comparison of 30-day stroke and/or death rate with those reported in the SAMMPRIS trial.…”