Initial experience with an everolimus-eluting, second-generation drug-eluting stent for treatment of intracranial atherosclerosis

Background and purpose High in-stent restenosis (ISR) rates have been reported after treatment of intracranial atherosclerotic stenosis (ICAS). Balloon-mounted drug-luting stent (DES) implantation has led to an ISR reduction in coronary vessels and may provide a solution to overcome this obstacle in the intracranial circulation. We present our initial experience with the everolimus-eluting stent (EES; Abbott Vascular, Abbott Park, Illinois, USA), a second-generation balloon-mounted DES, for ICAS treatment. Methods A retrospective review of prospectively collected endovascular data at our institution resulted in the identification of six patients with ICAS treated with EES. Data collected included patient demographics, presentation, comorbidities and lesion, intervention and follow-up details. Results These six patients had >70% angiographic ICAS and history of stroke or recurrent transient ischemic attacks, despite aspirin therapy and medical management of comorbidities. Lesions were located in the V4-vertebral artery segment (n-2), M1 middle cerebral artery segment (n=1), proximal basilar artery (n=1), supraclinoid internal carotid artery (n=1) and petrous internal carotid artery (n=1). Average stenosis severity was 82.8 +/- 6.6% (median, 80%); average lesion length was 10.2 +/- 2.2 mm. Stent placement was successful in all cases. Average postintervention stenosis was 5.5 +/- 4.4% (median, 7.5%). One patient had postintervention reperfusion hemorrhage that required urgent decompressive craniectomy. None of the five patients with angiographic follow-up (5-6 months) had ISR. The six patients had 4-10 months of clinical follow-up. Only the patient with reperfusion hemorrhage had decreased functional status after treatment (modified Rankin scale score=4) and is making a slow recovery. Conclusion This study confirms feasibility of use of a second-generation DES for ICAS and provides short-term follow-up results.