Sirolimus Drug-Eluting Stent (DES) in Vertebral Artery Ostial Stenosis: Insights from a Multicenter Analysis

Background and Purpose Vertebral artery ostial stenosis (VAOS) is a key contributor to posterior circulation ischemia. While drug-eluting stents (DES) have reduced restenosis rates in coronary applications, their efficacy in VAOS remains underexplored. This multicenter retrospective study evaluates the safety, efficacy, and restenosis predictors of sirolimus DES in VAOS, with comparison between transradial (TRA) and transfemoral (TFA) approaches. Methods Between January 2022 and February 2024, 142 patients (150 lesions) with symptomatic or severe asymptomatic VAOS were treated with sirolimus DES across three centers. Procedural data, follow-up imaging, and clinical outcomes were analyzed. In-stent restenosis (ISR) was defined as > 50% luminal narrowing within or adjacent to the stent. Results The overall ISR rate was 4.6% (5/109 lesions). Independent predictors of ISR included higher baseline stenosis (OR 0.88; 95% CI 0.81–0.96; P = 0.004), Type II aortic arch (OR 8.92; 95% CI 2.11–37.72; P = 0.003), and higher BMI (OR 1.32; 95% CI 1.10–1.58; P = 0.002). No 30-day stroke or mortality events occurred. TRA and TFA had comparable ISR rates (4.8% vs. 8.0%; P = 0.353), with TRA associated with higher inflation pressures and smaller stent diameters. Conclusions Sirolimus DES implantation for VAOS appears safe and effective, with low restenosis and no periprocedural adverse events. Anatomical factors, particularly aortic arch configuration, influence ISR risk. sirolimus DES represents a promising option for VAOS treatment, warranting further prospective validation.