Published Online
on September 7, 2006

A more recent version of this article appeared on October 1, 2006

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Submitted on June 1, 2006
Revised on June 28, 2006
Accepted on July 12, 2006

Safety, Feasibility, and Short-Term Follow-Up of Drug-Eluting Stent Placement in the Intracranial and Extracranial Circulation

Rishi Gupta MD; Firas Al-Ali MD; Ajith J. Thomas MD; Michael B. Horowitz MD; Thomas Barrow RN; Nirav A. Vora MD; Ken Uchino MD; Maxim D. Hammer MD; Lawerence R. Wechsler MD; and Tudor G. Jovin MD^*

From the Department of Neurology (R.G., N.A.V., K.U., M.D.H., L.R.W., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pa; the Department of Neurology (R.G.), Michigan State University, East Lansing; Neurosurgery of Kalamazoo, LLC (F.A.-A., T.B.), Kalamazoo, Mich; and the Department of Neurosurgery (A.J.T., M.B.H., T.G.J.), University of Pittsburgh Medical Center, Pittsburgh, Pa.

^* To whom correspondence should be addressed. E-mail: jovintg{at}upmc.edu.

Background and Purpose--The use of bare metal stents to treat symptomatic intracranial stenosis may be associated with significant restenosis rates. The advent of drug-eluting stents (DESs) in the coronary circulation has resulted in a reduction of restenosis rates. We report our technical success rate and short-term restenosis rates after stenting with DESs in the intracranial and extracranial circulation.

Methods--This study was a retrospective review of the period between April 1, 2004, and April 15, 2006, of 59 patients with 62 symptomatic intracranial or extracranial atherosclerotic lesions at 2 medical centers (University of Pittsburgh and Borgess Medical Center).

Results--The mean age of our cohort was 61±12 years. The location of the 62 lesions was as follows: extracranial vertebral artery 31 (50%), intracranial vertebral artery or basilar artery 18 (29%), extracranial internal carotid artery (ICA) near the petrous bone 5 (8%), and intracranial ICA 8 (13%). There were 2 (3%) periprocedural complications: 1 non--flow-limiting dissection and 1 disabling stroke. Fifty vessels were available for follow-up angiography or computed tomography angiography at a median time of 4.0±2 months. A total of 2 of 36 extracranial stents (7%) and 1 of 26 intracranial stents (5%) were found to have restenosis 50% at follow-up.

Conclusions--This report demonstrates that DES delivery in the intracranial and extracranial circulation is technically feasible. A small percentage of patients developed short-term in-stent restenosis. Longer-term follow-up is required in the setting of a prospective study to determine the late restenosis rates for DESs in comparison with bare metal stents.

Key words: angioplasty • intracranial stenosis • stenting • stents

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