Safety and efficacy of extracranial vertebral artery stenting in elderly patients with symptomatic vertebral artery stenosis.

Objectives: 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. Conclusion: 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.