Safety and Efficacy of Extracranial Vertebral Artery Stenting in Elderly Patients with Symptomatic Vertebral Artery Stenosis

Miao WuZhi yong Zhang^*

• Beijing Geriatric Hospital, Beijing, China

Objective:Symptomatic stenosis of the extracranial vertebral artery is an important cause of posterior circulation stroke..Endovascular stenting has shown promise for these lesions, but evidence in patients aged ≥70 years is limited.This study assessed perioperative safety and intermediate-term efficacy of extracranial vertebral artery stenting in elderly patients (≥70 years) by comparing rates of complications, restenosis, stroke, and death with those in younger patients.Methods: We retrospectively analyzed patients with symptomatic extracranial vertebral artery stenosis(VAS) treated at our center from 2019 to 2024. Patients were divided into two groups (≥70 vs <70 years). All patients had failed medical therapy (antiplatelet ± statin) and underwent stent placement. We compared perioperative adverse events, in-stent restenosis (ISR), target-vessel stroke, and any stroke or death between groups. Results: Among 224 patients (93 aged ≥70, 131 aged <70), technical success was 100%. Median age was 74 (IQR 72–77) in the ≥70 group and 63 (IQR 59–66) in the <70 group. Perioperative complication rates did not differ significantly (4.3% vs. 3.1%; p=0.721). Over a mean follow-up of 15 months, ISR occurred in 13.5% of ≥70 patients and 17.6% of <70 patients (p=0.50), and target-vessel stroke occurred in 3.3% vs. 1.6% (p>0.05). Multivariate analysis showed that bare-metal stent use and hyperuricemia independently predicted ISR. However, the combined outcome of any stroke or death was significantly higher in the ≥70 group than in the <70 group (14.6% vs. 3.2%, log-rank p<0.05), which was largely attributed to more severe atherosclerosis and a higher burden of comorbidities in the older population.Conclusions: In symptomatic patients with extracranial VAS, endovascular stenting in the elderly (≥70 years) appears comparably safe to younger patients, with similarly low restenosis and target-stroke rates. Use of bare-metal stents and hyperuricemia were associated with higher ISR.These findings support considering vertebral stenting in elderly patients, but emphasize the need for close follow-up.