Bioresorbable Vascular Scaffolds in Interventional Neuroradiology

Bioresorbable vascular scaffolds (BVS) have changed practice patterns in cardiology. These resorbable stents have not yet been utilized in the cerebrovascular circulation. We report the initial experiences with these devices in interventional neuroradiology.

A retrospective review of clinical presentations, imaging findings and follow-up results of all patients treated using a BVS by our neurovascular team was carried out using hospital electronic charts and the hospital radiographic archive system. Treatment was performed only if patients had a non-tortuous cerebrovascular anatomy suitable for navigation by the bulky BVS.

In this study 9 patients (5 women, mean age 51.3 years) were treated with Absorb or DeSolve scaffolds without permanent morbidity or mortality, 5 had intracranial or vertebral artery stenosis and in 4 patients with cerebral aneurysms scaffold-assisted coiling was performed. At a mean follow-up of 22.3 months, 1 parent artery in the aneurysm group was occluded and the remaining BVSs showed no significant restenosis. Fusiform luminal enlargement was demonstrated in one aneurysm patient. In two patients treated for stenosis, transient intra-arterial filling defects resembling BVS struts (scaffold silhouette) was demonstrated on early follow-up angiograms. In the patient with parent artery occlusion (who was judged to have unjailed the internal carotid bifurcation) and in the patient with luminal remodeling, we were able to discontinue all antiplatelet medications at 3 years without any consequences.

Absorbable stent technology has potential applications in interventional neuroradiology. We suggest that BVS should be optimized for cerebral circulation if prospective studies are to be undertaken for cerebrovascular applications of BVS.