Safety and efficacy of extracranial vertebral artery stenting in elderly patients with symptomatic vertebral artery stenosis

Objectives Symptomatic stenosis of the extracranial vertebral artery is an important cause of posterior circulation stroke. Endovascular stenting has shown promise for these lesions, but evidence in patients aged ≥ 70 years is limited. This study assessed perioperative safety and intermediate-term efficacy of extracranial vertebral artery stenting in elderly patients (≥70 years) by comparing rates of complications, restenosis, stroke, and death with those in younger patients. Methods We retrospectively analyzed patients with symptomatic extracranial vertebral artery stenosis (VAS) treated at our center from 2019 to 2024. Patients were divided into two groups (≥70 vs. <70 years). All patients had failed medical therapy (antiplatelet ± statin) and underwent stent placement. We compared perioperative adverse events, in-stent restenosis (ISR), target-vessel stroke, and any stroke or death between groups. Results Among 224 patients (93 aged ≥ 70, 131 aged < 70), technical success was 100%. Median age was 74 (IQR 72–77) in the ≥70 group and 63 (IQR 59–66) in the <70 group. Perioperative complication rates did not differ significantly (4.3% vs. 3.1%; p = 0.721). Over a mean follow-up of 15 months, ISR occurred in 13.5% of ≥70 patients and 17.6% of <70 patients ( p = 0.50), and target-vessel stroke occurred in 3.3% vs. 1.6% ( p > 0.05). Multivariate analysis showed that bare-metal stent use and hyperuricemia independently predicted ISR. However, the combined outcome of any stroke or death was significantly higher in the ≥70 group than in the <70 group (14.6% vs. 3.2%, log-rank p < 0.05), which was largely attributed to more severe atherosclerosis and a higher burden of comorbidities in the older population. Conclusion In symptomatic patients with extracranial VAS, endovascular stenting in the elderly (≥70 years) appears comparably safe to younger patients, with similarly low restenosis and target-stroke rates. Use of bare-metal stents and hyperuricemia were associated with higher ISR. These findings support considering vertebral stenting in elderly patients, but emphasize the need for close follow-up.