Original paper
Symptomatic vertebral artery stenting with the use of bare metal and drug eluting stents

Aim: To prospectively evaluate short and long-term clinical and angiographic outcome of vertebral artery stenting (VAS), with bare metal or drug eluting stents (BMS/DES) for symptomatic (vertebro-basilar stroke, drop attacks, severe vertigo, haemianopia or cortical blindness) vertebral artery stenosis.
Methods: The study involved 52 patients (mean age 65.9 ± 8.8 years, 42 men) with symptomatic vertebral artery stenosis. All were seen by an independent neurologist prior to VAS (referral), and after VAS (at 24 h, 1 and 12 months). Conventional angiography was performed at baseline, immediatelly after VAS and at 12 (9-14) months.
Results: The lesion location was left vertebral artery in 30 and right vertebral artery in 22. Twenty-six BMS and 26 DES were implanted. Stenosis severity (quantitative angiography diameter stenosis) was reduced from 85.4 ± 9% to 4.3 ± 5.7% (p < 0.01). At 30 days, 47 (90.4%) patients were asymptomatic, and 40 (80%) remained asymptomatic at 12 months (the only remaining symptoms were vertigo/dizziness). At 12 months there were no strokes, but there were 2 cardiac deaths. 12-month angiographic binary restenosis rate was 23.1 vs. 8.5% (BMS vs. DES).
Conclusions: The VAS for symptomatic vertebral artery stenosis is safe and effective in symptom relief. Our results indicate that the use of DES may lead to a significant reduction of restenosis rate at 12 months. Thus a large, randomized trial with DES vs. BMS for the treatment of symptomatic VAS is needed.