Comparison of self-expandable stents and balloon-mounted stents in the treatment of symptomatic intracranial vertebral artery atherosclerotic stenosis.

Objective: To compare the safety and efficacy of self-expandable stents (SES) and balloon-mounted stents (BMS) in the treatment of severe symptomatic intracranial vertebral artery atherosclerotic stenosis (SIVAAS).

Methods: The clinical and imaging data of 76 consecutive cases who were stented for SIVAAS in our centers in ten years were reviewed retrospectively. The cases were divided into SES group and BMS group as per the type of stents. Conventional risk factors of atherosclerosis, the relationship between stenosis and the origin of posterior inferior cerebellar artery (PICA), whether the stenosis was located at the dural-entry zone of the vertebral artery (VA), the interventional access, periprocedural complications, and clinical and imaging follow-up results were analyzed statistically.

Results: 77 stenotic lesions in 76 cases were included. Totally 51 SES and 26 BMS were implanted successfully. There was no significant difference in periprocedural complications (1 vs. 2, P = 0.544), incidence of restenosis (13.2% vs. 14.3%, P = 0.628) and long-term death or stroke (4 vs. 7, P = 0.33) between the two groups. The degree of residual stenosis in SES group was higher than in BMS group (10 (0%-40%) vs. 0 (0%-15%); P = 0). More BMS were selected in lesions located at the dural-entry zone of VA (45.1% vs. 73.1%, P = 0.02). There were more BMS implanted when lesions located proximal to origin of PICA (SES vs. BMS = 23.5% vs. 57.7%, P = 0.003) or when lesions with straighter access (SES vs. BMS = 29.4% vs. 69.2%, P = 0.001). More SES implanted when lesions located distal to PICA (SES vs. BMS = 43.1% vs. 15.4%, P = 0.015) or when lesions with moderate tortuous access (SES vs. BMS = 60.8% vs. 23.1%, P = 0.002). For stenotic lesions with moderate tortuous interventional access, SES group cases had longer survival time without stroke or death (P = 0.008).

Conclusion: Both SES and BMS showed high safety and efficacy for the treatment of SIVAAS. SES was more recommended for the stenotic lesions with tortuous interventional access. BMS was more recommended for the lesions located at the dural-entry zone of VA or proximal to PICA origin.