Experience with the Onyx Frontier Zotralimus-Eluting Stent: Outcomes for the interventional treatment of intracranial atherosclerotic disease

Abstract

Background: Intracranial atherosclerotic disease (ICAD) is a common cause of stroke worldwide. Aggressive medical therapy is the first line of treatment, which includes dual antiplatelet therapy for the initial 90 days followed by a single agent, in addition to controlling the associated risk factors. Previous trials demonstrated that endovascular treatment with stenting was inferior to medical management due to significant increased risk of perioperative stroke. However, some patients with ICAD are at risk of stroke recurrence despite appropriate medical management. Therefore, endovascular management can be considered on a case-by-case basis. Currently, there is still controversy regarding endovascular options for symptomatic ICAD. In this manuscript, we present our initial experience with the new generation Onyx Frontier drug-eluting stent in the treatment of symptomatic ICAD.

Methods: Retrospective review of patients who underwent placement of Onyx Frontier drug-eluting stents for the treatment of symptomatic ICAD at our center from May 2022 to November 2022.

Results: Six patients were identified. 9 Onyx Frontier stents were deployed for 7 distinct intracranial atherosclerotic lesions. Four patients had mRS of 0 at 90 days, one patient had mRS of 6 (from significant brainstem stroke) and one patient was lost to follow-up.

Conclusion: Our study demonstrates the utilization of the Onyx Frontier drug-eluting stent in the treatment of refractory symptomatic ICAD. The majority of post-treatment results were favorable except for one case of fatal brainstem stroke. Large prospective multicenter studies are needed to formally evaluate the use of drug-eluting stents in refractory symptomatic ICAD.