Drug-eluting stents versus bare-metal stents in the treatment of drug-refractory intracranial atherosclerotic disease: a retrospective single-center comparison

TL;DR

This study compares drug-eluting and bare-metal stents for treating intracranial atherosclerosis, finding drug-eluting stents reduce complications and restenosis.

Contribution

Demonstrates that drug-eluting stents may outperform bare-metal stents in treating intracranial atherosclerosis.

Findings

DES had significantly lower periprocedural complication rates compared to BMS.

DES showed lower in-stent restenosis rates due to sirolimus reducing endothelium irritation.

Patient demographics and comorbidities were comparable between the two groups.

Abstract

Due to several issues with endovascular treatment of intracranial symptomatic atherosclerotic disease (ICAD), international guidelines recommend drug therapy as first-line treatment since almost 10 years. Regardless of this, endovascular ICAD treatment has meanwhile progressed, significantly reducing periprocedural complication rates.

However, early in-stent restenosis (ISRS) remains, so far, unchallenged.

Cardiologists had been at a similar point in the evolution of cardiac artery stenting and challenged ISRS through drug-eluting stents (DES).

Therefore, 90d results and restenosis rates of patients treated with DES versus bare-metal stents (BMS) were compared to determine whether DES could also solve the neurovascular problem.

All endovascular ICAD treatments in 2014–2022 at a single institution through DES were retrospectively compared to all BMS-treatments in regards to periprocedural complications and ISR rates. Perioperative procedures and drug regimen were comparable for all patients, follow-up was carried out 90 days after treatment through digital subtraction angiography, clinical status was recorded by a board certified neurologist.

Fifty-two patients were treated for ICAD with DES, 26 patients received ICAD-treatment with BMS. Patients’ demographics and comorbidities were comparable. The periprocedural and ISR-rates were significantly lower in DES compared to BMS.

The lower periprocedural complication rate may be due to less complexity of the DES system, while lower ISR in the DES group may be connected to reduced endothelium irritation and proliferation through the eluted sirolimus.

In the population studied, DES achieved equal to better results in comparison to BMS. This study supports a re-evaluation of the role of endovascular ICAD-treatment as first line therapy in the light of the most recent developments on knowledge and techniques.

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