Drug-eluting stents for the treatment of intracranial atherosclerosis - Initial experience and midterm angiographic follow-up

Background and Purpose - Intracranial stenting is associated with a 32% rate of restenosis. Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease and have greatly reduced the risk of in-stent stenosis. We present our experience with the feasibility and safety of using DES for patients with symptomatic intracranial atherosclerosis. Methods - All of the patients had > 70% stenoses and had failed maximal medical therapy. They were pretreated with aspirin, clopidogrel, and intraprocedural heparin. All of the lesions were predilated, and balloons and stents were slightly undersized. Clopidogrel and aspirin were continued for 1 year, and patients had clinical follow-up and vascular imaging at 30 days, 6 months, and 1 year. Results - Eight patients with intracranial internal carotid artery (3), middle cerebral (2), basilar (2), and vertebral artery (1) stenoses were successfully treated with 4 Cypher (Cordis Corp) and 4 Taxus (Boston Scientific Inc) stents. The mean stenosis severity was reduced from 84.4% +/- 10.2% to 2.5% +/- 4.6%. One patient had an intraprocedural retinal embolism, but there were no other complications. Over a mean follow-up of 11.1 +/- 4.9 months (range, 2 to 17.3 months), patients have had repeat angiography (5) or transcranial Doppler with or without CT angiography (3). None of the patients have had clinical or significant angiographic restenosis or required target vessel revascularization. Conclusions - Elective intracranial stenting with DES appears to be feasible and safe, but additional clinical experience is required to assess its efficacy.