Preliminary evidence supporting the safety of drug-eluting stents in neurovascular disease

Objective: Restenosis is a significant complication of stent placement. With coronary revascularization, drug-eluting stents have significantly decreased the incidence of in-stent stenosis and, therefore, the morbidity of the procedure. Restenosis is potentially a significant problem for neurovascular disease. We therefore report our institutional experience on the use of drug-eluting stents for the management of cerebrovascular insufficiency. Methods: Over a period of 2 years, 19 patients underwent extra- and intracranial drug-eluting stent placement or intra- and extracranial atherosclerotic disease. There were 12 males and seven females aged between 36 and 83 years old (mean 65). Thirteen heparin, three rapamycin, and three taxus-coated stents were placed. There were five intracranial internal carotid arteries, two intracranial vertebral arteries, three mid-basilar, six of vertebral artery origin and three middle cerebral artery stents utilized. No complications occurred. Results: There was one case of re-stenosis associated with recurrent symptoms requiring repeat drug eluting stent placement. No other patients have developed new or recurrent neurological symptoms. Five of six vertebral artery origin stents were placed with distal protection to prevent embolic complications. Conclusion: Intracranial and extracranial drug-eluting stent placement appears to be a safe alternative to the medical management of atherosclerotic disease of the vertebrobasilar and carotid systems. However, further randomized studies are needed to examine the effectiveness and safety of this procedure.