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Introduction Intracranial atherosclerotic disease (IAD) causing intracranial arterial stenosis (ICS) is a main risk factor for stroke and death. A main reason for RS after intracranial arterial stenosis is seen in neointimal hyperplasia causing restenosis. In the non-neurovascular setting, drug-eluting endovascular devices are frequently used to challenge neointimal hyperplasia. However, drug-eluting stents (DES) are still only used to a limited extent in neurointerventional procedures.Aim of Study We therefore analyzed the effect of DES and the comparison with non-coated stents (BMS) in the endovascular treatment of drug-refractory IADs.Method We analyzed the outcome of all patients who received de endovascular treatment of intracranial arterial stenosis caused by IAD with DES or BMS at our institution between 2014 and 2022. Patients had to be clinically or radiologically demonstrably symptomatic under best medical treatment prior to the endovascular procedure. Clinical follow-up examinations as well as digital subtraction angiography 3 and 6 months after treatment were analyzed for new ischemia/RS, changes in mRS score and restenosis.Results 87 patients were included in the analysis. 52 patients received treatment with the Coroflex® ISAR NEO stent, 26 patients with non-coated stents. Patients treated with DES had a longer time to retreatment. With DES, the risk of complications was generally lower than with the other treatments. In-stent restenosis occurred in 2 patients (3,8%) in the DES group vs. 9 patients (34,6%) in the BMS-group.Conclusion DES for the treatment of drug-refractory intracranial stenoses arising from IAD are, in our experience, a viable and safe treatment option compared to treatment with BMS.Conflict of Interest No