A172 Endovascular treatment of in-stent restenosis after vertebral artery ostial stenting: incidence, risks and outcomes

<h3>Introduction</h3> In-stent restenosis (ISRS) is a major concern following vertebral artery (VA) ostial stenting, potentially leading to recurrent symptoms or ischemic strokes. Despite the growing use of endovascular treatment for VA ostial stenosis, data on efficacy and safety of the endovascular re-treatment for ISRS is sparse. <h3>Aim of Study</h3> To evaluate the frequency of ISRS after VA ostial stenting and assess the safety and effectiveness of endovascular reinterventions. <h3>Method</h3> Single-center retrospective analysis included patients who underwent the re-treatment with drug-coated balloon (DCB) angioplasty or re-stenting for ISRS &gt;50%. The angiographic follow-up was performed in all cases following re-treatment. Periprocedural neurological events, need for re-treatment, and follow-up outcomes were systematically evaluated. <h3>Results</h3> ISRS &gt;50% was identified in 86 stents (15.2%) at a mean interval of 11.9 months (range: 1–139 months) following 564 stenting procedures for VA ostial stenosis in 525 patients. No recurrent strokes occurred after the initial stent angioplasty. One patient experienced a TIA, and six reported recurrent vertigo. Re-treatment was performed in 85 cases, using drug-eluting balloon-mounted stents in 41.2% and drug-coated balloons in 58.8% of cases. No periprocedural strokes were observed. Recurrent ISRS was detected in 18 (21.2%) stents at a mean of 22.6 months post-reintervention. Tobacco use and dyslipidemia were significantly associated with the development of ISRS. <h3>Conclusion</h3> Re-treatment with DES or DCB is shown to be a safe and effective treatment for managing the ISRS. Treating comorbidities and adopting lifestyle changes may further reduce the risk of ISRS. <h3>Conflict of Interest</h3> No