Vertebral artery ostial stenting shows 15.8% in-stent restenosis rate in retrospective cohort
This retrospective cohort study analyzed 564 vertebral artery ostial stenting procedures in 525 patients at a single center. The primary outcome was the incidence of in-stent restenosis (ISRS) >50% and the safety and effectiveness of endovascular re-interventions, which included balloon angioplasty with drug-coated balloons or re-stenting with drug-eluting balloon-mounted stents. No comparator group was reported.
The incidence of ISRS >50% after initial stenting was 15.8% (89 stents out of 564 procedures). The majority of these cases (70 out of 89) were diagnosed within the first year, with a median time of 7 months. Among 88 cases that underwent re-treatment for recurrent ISRS, the recurrence rate after re-treatment was 21.6% (19 stents). Tobacco use and dyslipidemia were significantly associated with both ISRS development and recurrence, though no causation was established.
Regarding safety, no periprocedural strokes were observed. Adverse events, discontinuations, and tolerability were not reported. Key limitations include the single-center, retrospective design and the lack of randomization or a control group. The mean follow-up was 56 months after initial stenting and 23.2 months after re-treatment. Practice relevance is restrained; while re-treatment appears safe in this cohort, the high recurrence rates and observational nature of the data suggest careful patient selection and emphasis on risk factor management, such as smoking cessation, are warranted.
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