One-Year Clinical and Imaging Outcomes After Dedicated Sirolimus-Eluting Stenting for Symptomatic Vertebral Artery Origin Stenosis: A Real-World Cohort Study

BACKGROUND: Dedicated sirolimus-eluting stents designed for vertebral artery origin anatomy have recently been introduced for the treatment of symptomatic vertebral artery origin stenosis (VAOS). However, real-world data on predefined 1-year imaging outcomes and device-related complications remain limited. METHODS: This single-center retrospective cohort study included consecutive patients with symptomatic VAOS treated with dedicated sirolimus-eluting vertebral artery stents between January 2021 and November 2024. Periprocedural complications, 1-year clinical outcomes, modified Rankin Scale (mRS) scores, and imaging findings were analyzed. Logistic regression was used to identify predictors of in-stent restenosis (ISR). Exploratory analyses compared outcomes between different stent platforms. RESULTS: A total of 168 patients were included, and technical success was achieved in all procedures. Periprocedural complications occurred in 5.5%, including major events in 1.2%. At 1 year, ISR occurred in 13% and was predominantly asymptomatic, while stent fracture was observed in 12%. During follow-up, transient ischemic attack occurred in 1.8%, target-vessel-related ischemic stroke in 1.2%, and non-target-vessel ischemic stroke in 2.4%. Major bleeding occurred in 0.6%, and all-cause mortality was 1.2%. Functional status improved significantly and remained improved at 1 year (P < 0.001). Severe stenosis or occlusion of the contralateral vertebral artery independently predicted ISR (adjusted OR 4.50; 95% CI 1.81-11.19; P = 0.001). Clinical and imaging outcomes were comparable between stent platforms. CONCLUSIONS: Dedicated sirolimus-eluting vertebral artery stenting appears safe and effective in real-world practice, with acceptable 1-year patency and sustained functional improvement. Contralateral vertebral artery disease independently predicts ISR, highlighting the role of posterior circulation hemodynamics.