Vertebral artery ostial stenosis (VAOS) is a key contributor to posterior circulation ischemia. While drug-eluting stents (DES) have reduced restenosis rates in coronary interventions, their efficacy in VAOS remains under-explored This multicenter retrospective study evaluates the safety and efficacy of sirolimus DES for VAOS and explores factors associated with in-stent restenosis (ISR), with comparison between transradial (TRA) and transfemoral (TFA) approaches. Between January 2022 and February 2024, 142 patients (151 lesions) with symptomatic or severe asymptomatic VAOS were treated with sirolimus DES across three centers. Procedural characteristics, imaging follow-up, and clinical outcomes were analyzed. ISR was defined as > 50% luminal narrowing within or adjacent to the stent. Imaging follow-up was available for 109/151 lesions (72.2%). The overall ISR rate was 4.6% (5/109 lesions). On univariable analysis, ISR was associated with greater baseline stenosis severity, Type II aortic arch anatomy, and higher body mass index. No 30-day stroke or mortality events occurred. TRA and TFA demonstrated comparable ISR rates (4.8% vs. 8.0%; P = 0.353). TRA cases were associated with higher balloon inflation pressures and smaller stent diameters. Sirolimus DES implantation for VAOS appears safe and effective, with low restenosis and no periprocedural adverse events. Anatomical factors, particularly aortic arch configuration, may be associated with ISR risk. Sirolimus DES represent a promising option for selected VAOS patients, warranting further prospective validation.
Zhu et al. (Sat,) studied this question.
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