Drug-coated balloon angioplasty for symptomatic vertebral artery origin stenosis: a real-world analysis of efficacy and predictors for bailout stenting

Objective This study aims to evaluate the preliminary efficacy and safety of drug-coated balloon (DCB) angioplasty for treating symptomatic vertebral artery origin stenosis (VAOS) in a real-world setting and to investigate potential factors necessitating intraoperative bailout stenting (BS). Methods This single-center retrospective study enrolled 121 consecutive symptomatic VAOS patients treated with DCB angioplasty at Xuzhou First People’s Hospital between January 2022 and December 2024. Patients were classified into the DCB group or the BS group based on the requirement for intraoperative bailout stenting. Stenosis rates were compared within the DCB group at baseline, immediately post-procedure, and at ≥3- and ≥12-month follow-up, as well as between the DCB and BS groups at corresponding time points. The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were used for variable selection, and a nomogram was constructed and evaluated using the concordance index ( C -index) and the Hosmer–Lemeshow goodness-of-fit test. Results Technical success was achieved in 94 patients (77.6%), while bailout stenting was required in 27 patients (22.3%). The median stenosis of the DCB group decreased from 83% at baseline to 36% immediately post-procedure ( p 0.001) and remained stable at ≥3 months (43%) and ≥12 months (45%). At ≥3 months, stenosis was lower in the DCB group than in the BS group (40.5% vs. 47%, p 0.05), whereas no significant difference was observed at ≥12 months (48% vs. 69%, p = 0.17). Multivariable analysis identified elevated diastolic blood pressure odds ratio (OR) = 1.051, 95% CI: 1.011–1.093 and concomitant internal carotid artery stenosis (moderate stenosis: OR = 8.377, 95% CI: 1.977–35.493; severe stenosis or occlusion: OR = 6.346, 95% CI: 1.493–26.975) as independent predictors of bailout stenting. The nomogram demonstrated good discrimination ( C -index = 0.807, 95% CI: 0.709–0.906) and adequate calibration ( p = 0.9158). Conclusion DCB angioplasty was associated with favorable angiographic durability in symptomatic VAOS, with similar long-term patency between balloon-only and bailout stent strategies. Higher diastolic blood pressure, and concomitant carotid stenosis were associated with bailout stenting.