Sirolimus Drug-Eluting Stent (DES) in Vertebral Artery Ostial Stenosis: Insights from a Multicenter Analysis

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While drug-eluting stents (DES) have reduced restenosis rates in coronary applications, their efficacy in VAOS remains underexplored. This multicenter retrospective study evaluates the safety, efficacy, and restenosis predictors of sirolimus DES in VAOS, with comparison between transradial (TRA) and transfemoral (TFA) approaches. Methods Between January 2022 and February 2024, 142 patients (150 lesions) with symptomatic or severe asymptomatic VAOS were treated with sirolimus DES across three centers. Procedural data, follow-up imaging, and clinical outcomes were analyzed. In-stent restenosis (ISR) was defined as > 50% luminal narrowing within or adjacent to the stent. Results The overall ISR rate was 4.6% (5/109 lesions). Independent predictors of ISR included higher baseline stenosis (OR 0.88; 95% CI 0.81–0.96; P = 0.004), Type II aortic arch (OR 8.92; 95% CI 2.11–37.72; P = 0.003), and higher BMI (OR 1.32; 95% CI 1.10–1.58; P = 0.002). No 30-day stroke or mortality events occurred. TRA and TFA had comparable ISR rates (4.8% vs. 8.0%; P = 0.353), with TRA associated with higher inflation pressures and smaller stent diameters. Conclusions Sirolimus DES implantation for VAOS appears safe and effective, with low restenosis and no periprocedural adverse events. Anatomical factors, particularly aortic arch configuration, influence ISR risk. sirolimus DES represents a promising option for VAOS treatment, warranting further prospective validation. Vertebral artery ostial stenosis Sirolimus-eluting stent Drug-eluting stent In-stent restenosis Transradial approach Figures Figure 1 Key Messages 1. What is known: Vertebral artery ostial stenosis is a common cause of posterior circulation stroke. Drug-eluting stents reduce in-stent restenosis in coronary applications, but data on their use in VAOS are limited. 2. What this study adds: Sirolimus DES are safe and effective for VAOS, with low ISR and no periprocedural complications. Both access routes are feasible, though anatomical factors predict ISR. 3. Clinical implications: Sirolimus DES may be preferred for select VAOS patients. Recognizing ISR risk factors can inform access route and surveillance strategies. Introduction Vertebral artery ostial stenosis (VAOS) contributes significantly to posterior circulation ischemic stroke, accounting for 20-25% of vertebrobasilar insufficiency cases[1, 2]. Despite optimal medical therapy, recurrent stroke remains frequent, with 5-year rates exceeding 30%[3]. Endovascular stenting has become a cornerstone for revascularization[4], yet in-stent restenosis (ISR) with bare-metal stents (BMS) remains a critical limitation, affecting 20–34% of treated lesions[5, 6]. Drug-eluting stents (DES) offer targeted inhibition of neointimal proliferation and have transformed coronary interventions by reducing ISR to under 10%[7] , [8]. However, their role in extracranial vertebral arteries remains underexplored. The vertebral artery’s tortuous path[1] and dynamic hemodynamic forces[9] necessitate stents with high radial strength and flexibility—characteristics addressed by the Maurora sirolimus-DES ( Alain Medical, Beijing, PRC ) constructed from cobalt-chromium alloy and coated with biodegradable sirolimus-polymer matrix[10]. While a few randomized trials / prospective studies in recent years had explored the use of DES for VAOS with some promising results, these are limited by modest sample sizes, restricted generalizability, and a lack of procedural variability seen in clinical practice.[7, 10] Comprehensive multicenter data on the sirolimus DES’s performance in VAOS are lacking. To date, only a handful of studies have evaluated sirolimus DES for VAOS specifically on access strategy, anatomical predictors, and ISR risk in a multicenter real-world setting. This study addresses that gap by offering pragmatic insights into DES implantation in VAOS, focusing on access strategies and anatomical factors associated with in-stent re-stenosis (ISR). Methods Patient Selection This multicenter retrospective study was approved by the Institutional Review Boards of three participating hospitals, with written informed consent obtained from all patients. Between January 2022 and February 2024, we enrolled 142 consecutive patients diagnosed with vertebral artery ostial stenosis (VAOS) treated with sirolimus DES; see Figure 1 . Clinical and procedural data were extracted from electronic medical records for analysis. Inclusion criteria: 1. Age >18 years 2. Diagnosis of VAOS with either: (a) Symptomatic stenosis ≥50% with ischemic stroke or TIA within the preceding 90 days, or (b) Asymptomatic stenosis ≥70% confirmed by digital subtraction angiography (DSA) 3. Use of antiplatelet therapy (aspirin or clopidogrel/ticagrelor) prior to stenting. Exclusion criteria: Patients who underwent mechanical thrombectomy during the index procedure. Endovascular Procedure Algorithm and Treatment Protocol Dual antiplatelet therapy (DAPT) with aspirin 100 mg/day and either clopidogrel 75 mg/day or ticagrelor 90 mg twice daily was initiated ≥7 days pre-procedure and continued for ≥6 weeks post-stenting. All procedures were performed under local anesthesia by three dedicated neurointerventional teams from three centers having at least 10 years of continuous hands-on experience. Vascular access, either transradial (TRA) or transfemoral (TFA) approaches was selected at the operating team’s discretion based on anatomical suitability and experience. This non-randomized approach may introduce access-selection bias; thus, future studies should consider a standardized protocol or randomized design to reduce variability and improve reproducibility. Systemic heparinization was administered to maintain an activated clotting time of 250–300 seconds. A 0.014-inch micro-guidewire was advanced through the lesion under fluoroscopic guidance, and Maurora sirolimus DES was deployed within the range of nominal and burst pressures for 15–20 seconds in all cases. In cases with intraprocedural thrombotic complications, intravenous tirofiban was administered. Follow-Up Angiographic follow-up (DSA, computed tomography angiography [CTA], or magnetic resonance imaging angiography [MRA]) was scheduled at 3, 6, and 12 months. Clinical assessments included the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). ISR was defined as >50% luminal stenosis within or adjacent to the stent (5 mm margins)[11]. Statistical Analysis Statistical analysis was performed using SPSS version 26.0 (IBM Corp., USA). Continuous variables are expressed as mean ± standard deviation (SD) and compared via Student’s t-tests. Categorical variables are reported as frequencies (%) and analyzed using χ² or Fisher’s exact tests. Multivariate logistic regression identified independent ISR predictors (p<0.05). Missing data, such as aortic arch type, were handled using multiple imputation. Results Patient Cohort & Baseline Characteristics 1. Differences between TRA and TFA patient groups Among 142 patients treated with sirolimus DES for 151 VAOS lesions (9 patients had bilateral VAOS lesions), baseline characteristics were generally well balanced between the TRA and TFA groups; see Table 1 . No significant differences were observed in age (69.7 ± 7.3 years), sex distribution (86.6% male), or hypertension prevalence (76.1%). However, certain risk factors showed statistically significant variation: Diabetes mellitus was more prevalent in TRA patients (TRA 48.5% vs TFA 29.3%, p=0.041). Smoking history was more prevalent in TFA patients (TFA 36.6% vs TRA 11.9%, p=0.001). Dyslipidemia (TFA 52.5% vs TRA 31.7%, p=0.027) and statin use (TFA 82.9% vs TRA 63.4%, p=0.027) were more frequent in the TFA cohort. Prior PCI was notably more prevalent in the TRA group (TRA 17.8% vs. TFA 2.4%, p=0.026). These baseline imbalances likely reflect real-world access selection patterns based on operator discretion and patient comorbidities. 2. Differences between patient groups with in-stent restenosis (ISR) and non-ISR on follow-up Among the 109 lesions on follow-up (40 VAOS lesions were lost to follow-up), ISR occurred in 5 (4.6%) cases; see Table S1 . Although higher body mass index (BMI) is more prevalent in these 5 post-stenting VAOS patients with ISR compared to non-ISR patients (25.1 ± 1.9 vs. 21.4 ± 7.8, p=0.007) with multivariate analysis hinting BMI as an independent predictor of ISR (adjusted OR 1.32; 95% CI 1.10–1.58; p=0.002), the limited positive ISR sample size (n=5) may have been underpowered, and findings should be interpreted with caution. No other baseline clinical variables including age, sex, diabetes, dyslipidemia, or antiplatelet/statin use differed significantly between these two groups. Procedural Characteristics (TRA versus TFA) 1. Differences between TRA and TFA patient groups Procedural metrics differed modestly between access routes (TRA in 110 cases and TFA in 41 cases); see Table 2 . TFA was associated with the use of larger DES with diameter of 4.4 ± 0.7 mm and lower maximal inflation pressures of up to 9.9±4.2 atm, whereas TRA tend to use smaller-sized DES with diameter of 4.0±0.9 mm and higher maximal inflation pressures of up to 11.5 ± 3.7 atm (p=0.017 and p=0.022 respectively), suggesting access-specific biomechanical considerations. No significant differences were found in lesion length, baseline stenosis severity, or post-dilation frequency. Anatomical features such as aortic arch configuration and vertebrobasilar anatomy were broadly comparable between groups, although Type II aortic arches were more frequently observed in TFA-treated lesions (TFA 58.3% vs TRA 39.4%), without reaching statistical significance (p=0.541). The frequency of intracranial atherosclerosis (ICAS) appeared higher in the TRA cohort (TRA 15.5% vs TFA 4.9%), with borderline significance (p=0.081), possibly reflecting selection bias. No significant neurologically disabling or life-threatening complications were reported in either group. Intraprocedural IV tirofiban use was more frequent in TFA group (TFA 4.9% vs TRA 0.0%, p=0.020), possibly reflecting higher perceived thrombotic risk. However, missing data on aortic arch type in 26.5% of lesions (particularly in TFA cases) may introduce information bias and limit definitive interpretation. Observed trends should be interpreted cautiously given the non-randomized design and potential for Type I error due to multiple testing. 2. Procedural predictors of in-stent re-stenosis (ISR) In 109 sirolimus DES-treated VAOS lesions (26.5% lost to follow-up), multivariate analysis suggested type II aortic arch anatomy as a possible predictor of ISR (adjusted OR 8.92; 95% CI 2.11–37.72; p=0.003), with all ISR cases occurring exclusively in Type II aortic arches; see Table 4 . Notably, aortic arch type data were missing in 25% of cases, which may introduce information bias. The small ISR sample (n=5) also limits the statistical power to detect modest associations and increases risk of Type II error. Thus, while the findings suggest anatomical and hemodynamic factors may contribute to ISR, these associations should be validated in larger prospective studies. Higher baseline stenosis severity was also significantly associated with ISR (74.1±10.1% vs. non-ISR 62.3±4.9%, p=0.003) and remained significant in multivariable analysis (adjusted OR 0.88; 95% CI 0.81–0.96; p=0.004), indicating increased ISR risk with more severe pre-treatment narrowing. Other procedural variables including lesion length, stent diameter, inflation pressure, and contralateral VA pathology did not significantly differ between groups. Follow-Up Outcomes 1. Differences between TRA and TFA patient groups Table 3 illustrated complete imaging follow-up in 109 of treated 151 VAOS lesions (72.2%), with a higher rate in TRA (76.4%) than TFA (61.0%) patient groups, though this did not reach statistical significance; p=0.061. Digital subtraction catheter angiography (DSA) was the predominant imaging modality in the TRA group (65.5%), while CTA (computed tomography angiogram) and/or MRA (magnetic resonance imaging angiography) was more frequently used in TFA cases (56.0%) with p=0.049, reflecting access-related surveillance practices. The mean angiographic follow-up duration did not differ significantly between groups. The overall ISR rate was low (5.5%) and similar between TRA (4.8%) and TFA (8.0%) groups (p=0.353). Mild intimal hyperplasia occurred in 21.1% of cases without group differences. Stent fracture was observed in 7 cases, all within the TRA cohort, though this trend did not reach significance (p=0.136). Only one patient in TRA group required target VAOS lesion re-intervention. Clinical follow-up was robust which 94.4% of patients were included, with comparable NIHSS and mRS scores between groups. TFA patients had a significantly longer mean clinical follow-up period (619.3±213.2 days vs. TRA 509.9±220.3 days; p=0.009), potentially influencing detection of late outcomes. No cases of 30-day stroke recurrence or mortality were reported in either cohort. 2. ISR vs. Non-ISR Among the 109 DES-treated VAOS lesions with follow-up imaging, ISR cases exhibited markedly worse imaging and clinical outcomes; see Table 5 . Follow-up stenosis severity was significantly higher in ISR lesions (56.3± 8.7% vs. non-ISR 17.3±12.7%; p<0.001) and remained an independent predictor of ISR in multivariate analysis (adjusted OR 1.25; 95% CI 1.12–1.40; p<0.001). All ISR cases were detected via DSA imaging, while non-ISR lesions were assessed using DSA or CTA/MRA (p<0.001), potentially reflecting differential surveillance intensity. Multivariate analysis confirmed that DSA imaging independently increased ISR detection likelihood (reference to CTA/MRA: OR 0.12; 95% CI 0.03–0.52; p=0.005). ISR was also associated with significantly higher rates of target lesion reintervention (20.0% vs. 0.0%; p=0.046; adjusted OR 12.5, 95% CI 1.20–130.5) and worse functional outcomes, as reflected by higher follow-up mRS scores (ISR 0.5±1.0 vs. non-ISR 0.0 ± 0.0; p<0.001; adjusted OR 0.15, 95% CI 0.03–0.75; P=0.021). No differences were noted in NIHSS scores or short-term clinical events, such as 30-day stroke recurrence or mortality. These findings underscore the clinical relevance of ISR, particularly its association with delayed stenotic progression, need for reintervention, and worse long-term disability despite the small ISR sample size (n=5), which may limit generalizability. Discussion This multicenter retrospective study provides real-world insights into the efficacy, safety, and procedural nuances of sirolimus drug-eluting stent (DES) implantation for vertebral artery ostial stenosis (VAOS), with a comparative lens on transradial (TRA) versus transfemoral (TFA) approaches. The low overall in-stent restenosis (ISR) rate of 4.6% and absence of significant peri-procedural complications underscore the procedural safety and promising long-term patency of sirolimus DES in the extracranial vertebral circulation. The observed ISR rate of 4.6% marks a substantial improvement over historical benchmarks for bare-metal stents (BMS), which report ISR rates of 20.6-33.6%[5, 6]. This favorable outcome is consistent with the anti-proliferative effects of sirolimus, which suppress smooth muscle cell growth and neointimal hyperplasia which mechanisms as documented in coronary DES applications[12]. The performance of sirolimus DES in our cohort parallels findings from other DES studies in both coronary and cerebrovascular territories[8, 13, 14]. Our findings suggest that both TRA and TFA are feasible and safe access strategies for VAOS intervention. Despite minor differences in stent sizing and inflation pressure, TRA did not increase complication rates and offered comparable clinical and angiographic outcomes. The higher TFA follow-up duration may reflect access-related imaging preferences or selection bias. These results align with coronary data favoring TRA for procedural comfort and fewer access-site complications, although further prospective validation in neurovascular contexts is needed. Several independent predictors of ISR in our study include high-grade baseline stenosis, higher body mass index, residual post-stent narrowing >15%, and notably, type II aortic arch anatomy which present in 100% of ISR cases. These findings may support the hypothesis that geometric complexity and altered shear stress may contribute to neointimal hyperplasia in vertebral stents.[13, 15] While causality cannot be confirmed, these associations may help refine procedural planning and risk stratification. While stent fractures were infrequent overall, they occurred in 20.0% of ISR lesions versus 5.8% of non-ISR lesions (p=0.287), a non-significant trend that may still carry biomechanical relevance. These findings suggest a multifactorial interplay involving stent material properties, lesion anatomy, and procedural technique[15, 16]. ISR was associated with significantly higher follow-up stenosis, worse mRS outcomes, and a 20% retreatment rate, highlighting its clinical burden even in a small sample. Interestingly, all ISR lesions were detected via DSA, reinforcing the need for high-fidelity imaging in long-term surveillance, particularly for patients with high-risk anatomy. The absence of early stroke recurrence or mortality supports sirolimus DES safety in both access routes, but the delayed functional impact of ISR warrants attention. This multicenter analysis adds valuable real-world evidence to the evolving landscape of endovascular treatment for VAOS. While prior studies on DES have been limited to single-center cohorts or small randomized trials, our study represents one of the largest multicenter evaluations of sirolimus DES performance in this anatomical context. The inclusion of anatomically diverse patients, variation in operator technique, and both TRA and TFA access routes enhance the external validity and generalizability of our findings. Importantly, the low ISR rate (4.6%) observed here not only supports prior reports on the efficacy of sirolimus DES in extracranial cerebrovascular applications but also establishes a benchmark for comparative studies against alternative modalities, such as drug-coated balloons (DCBs) with meta-analyses suggested ISR rates of 11.9%.[17] While DCB avoids permanent scaffold-related risks such as fracture and thrombosis[18] as well as reduces the need for prolonged dual antiplatelet therapy potentially lowering associated bleeding complications[19], our sirolimus DES-treated VAOS cohort may offer enhanced durability in anatomically complex or calcified VAOS lesions. As newer DES platforms including bioresorbable scaffolds and advanced polymer-drug systems are developed, comparative studies assessing efficacy, safety, and cost-effectiveness will be essential. Our findings establish a practical reference point for such comparisons and reinforce the potential of sirolimus DES as a first-line intervention for select VAOS patients. LIMITATIONS This study’s retrospective design introduces potential selection and information biases. Access route was operator-dependent, and data on arch anatomy was incomplete in 25% of cases. The small number of ISR events limits statistical power, and multivariate findings should be interpreted cautiously. Nonetheless, high follow-up rates and multicenter inclusion enhance generalizability, and our findings serve as a foundation for future prospective studies. Conclusion In this multicenter retrospective analysis, sirolimus DES demonstrated favorable efficacy and safety for the treatment of VAOS, with a low in-stent restenosis rate and no periprocedural complications. Both transradial and transfemoral approaches were viable, though anatomical factors such as Type II aortic arch and baseline stenosis were significantly associated with restenosis. These findings contribute meaningful real-world evidence supporting the role of sirolimus DES in extracranial cerebrovascular interventions and highlight the need for individualized procedural strategies. Further prospective studies are warranted to validate ISR predictors and benchmark sirolimus DES against emerging revascularization technologies. Abbreviations DES Drug-eluting stent VAOS Vertebral artery ostial stenosis ISR In-stent restenosis TRA Transradial approach TFA Transfemoral approach DSA Digital subtraction angiography CTA Computed tomography angiography MRA Magnetic resonance angiography NIHSS National Institutes of Health Stroke Scale mRS Modified Rankin Scale BMI Body mass index PCI Percutaneous coronary intervention ICAS Intracranial atherosclerosis DAPT Dual antiplatelet therapy Declarations Ethics and Consent to Participate declarations This was a retrospective study. No human subjects, human material, or human data was involved so that the ethics committee approval was not required. Author Contribution Acknowledgments： Conception and design: D.Z. and Y. F. Data acquisition: D.Z., B.L., and K.Z.. Analysis and interpretation of data: D.Z. and J.Z.. Critically revising the article: Y.F., S.Z.T. and X.L.. Y.F., S.Z.T. and X.L. reviewed the submitted manuscript. 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Ann Vasc Surg 64:157–162. 10.1016/j.avsg.2019.10.043 Tables Table 1 Patient Baseline Characteristics for TRA vs. TFA Variable Overall (N = 142) TRA (N = 101) TFA (N = 41) P-value Male Sex, N (%) 123 (86.6%) 87 (86.1%) 36 (87.8%) 1.000 BMI (Mean ± SD) 21.0 ± 8.2 21.1 ± 8.1 20.8 ± 8.4 0.889 Age (Mean ± SD) 69.7 ± 7.3 69.8 ± 7.2 69.6 ± 7.6 0.931 Hypertension, N (%) 108 (76.1) 76 (75.2%) 32 (78.0%) 0.830 Diabetes, N (%) 61 (43.0%) 49 (48.5%) 12 (29.3%) 0.041 * Coronary Artery Disease, N (%) 22 (15.5%) 19 (18.8%) 3 (7.3%) 0.124 Hyperhomocysteinemia, N (%) 43 (30.3%) 29 (28.7%) 14 (34.1%) 0.550 Dyslipidemia, N (%) 66 (46.5%) 53 (52.5%) 13 (31.7%) 0.027 * Smoking History, N (%) 27 (19.0%) 12 (11.9%) 15 (36.6%) 0.001 ** Prior Radial PCI, N (%) 19 (13.4%) 18 (17.8%) 1 (2.4%) 0.026 * Preoperative Antiplatelet Use, N (%) 99 (69.7%) 67 (66.3%) 32 (78.0%) 0.227 Preoperative Statin Use, N (%) 98 (69.0%) 64 (63.4%) 34 (82.9%) 0.027 * TIA, N (%) 48 (33.8%) 38 (37.6%) 10 (24.4%) 0.171 Stroke, N (%) 94 (66.2%) 63 (62.4%) 31 (75.6%) 0.154 TRA: transradial approach; TFA: transfemoral approach. BMI: body mass index; PCI: percutaneous coronary intervention; TIA: transient ischemic attacks. *Statistical significance: *P < 0.05, **P < 0.01, ***P < 0.001. Table 2 Procedural Characteristics for TRA vs. TFA Variable Overall (N = 151 † ) TRA (N = 110) TFA (N = 41) P-value Aortic Arch Type‡ 0.541 - Type 1, N (%) 45 (32.1%) 41 (41.4%) 4 (33.3%) - Type 2, N (%) 46 (32.9%) 39 (39.4%) 7 (58.3%) - Type 3, N (%) 20 (14.2%) 19 (19.2%) 1 (8.3%) Bovine Arch Prevalence, N (%)‡ 12 (8.6%) 10 (10.1%) 2 (16.7%) 0.621 Right Vertebral Artery Lesion, N (%) 91 (60.3%) 66 (60.0%) 25 (61.0%) 0.913 Basilar Artery Stenosis, N (%) 7 (4.6%) 5 (4.5%) 2 (4.9%) 0.931 Contralateral Vertebral Occlusion, N (%) 11 (7.3%) 7 (6.4%) 4 (9.8%) 0.476 Contralateral Vertebral Stenosis/Hypoplasia, N (%) 43 (28.5%) 32 (29.1%) 11 (26.8%) 0.784 Intracranial Vertebral Stenosis/Occlusion, N (%) 19 (12.6%) 17 (15.5%) 2 (4.9%) 0.081 Lesion Length (mm, Mean ± SD) 6.9 ± 3.4 7.0 ± 3.4 6.7 ± 3.3 0.645 Preoperative Stenosis (%, Mean ± SD) 73.4 ± 10.2 73.9 ± 10.2% 72.3 ± 10.2% 0.421 Residual Stenosis (%, Mean ± SD) 11.1 ± 10.3 10.1 ± 10.4% 13.0 ± 9.8% 0.120 Stent Length (mm, Mean ± SD) 14.1 ± 2.8 14.1 ± 3.0 14.1 ± 2.2 0.980 Stent Diameter (mm, Mean ± SD) 4.1 ± 0.9 4.0 ± 0.9 4.4 ± 0.7 0.017 * Maximal Inflation Pressure (atm, Mean ± SD) 11.0 ± 3.9 11.5 ± 3.7 9.9 ± 4.2 0.022 * Post-dilation, N (%) 18 (11.9%) 13 (11.8%) 5 (12.2%) 0.949 Procedure-related Complications, N (%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 Other Complications, N (%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 Tirofiban Use, N (%) 2 (1.3%) 0 (0.0%) 2 (4.9%) 0.020* TRA: transradial approach; TFA: transfemoral approach. †N = 151 lesions from 142 patients (9 bilateral cases, 6.3% of cohort). ‡Data available for 111/151 lesions (73.5%), with missing cases: 11 (TRA) and 29 (TFA). *Statistical significance: *P < 0.05, **P < 0.01, ***P < 0.001. Table 3 Follow-up Results for TRA vs. TFA Variable Overall TRA TFA P-value Imaging Follow-up Rate, n/N (%) † 109/151 (72.2%) 84/110(76.4%) 25/41 (61.0%) 0.061 Follow-up Modality 0.049 * - DSA, N (%) 66 (60.6%) 55 (65.5%) 11 (44.0%) - CTA/MRA, N (%) 43 (37.6%) 29 (32.1%) 14 (56.0%) Follow-up Period (Days, Mean ± SD) 244.2 ± 147.6 240.7 ± 133.8 264.2 ± 194.4 0.576 Follow-up Stenosis (%, Mean ± SD) 1 (0.9%) 18.5 ± 15.2% 21.0 ± 14.2% 0.478 ISR, N (%) 6 (5.5%) 4 (4.8%) 2 (8.0%) 0.353 Mild Intimal Hyperplasia, N (%) 23 (21.1%) 18 (21.4%) 5 (20.0%) 0.878 Stent Fracture, N (%) 7 (6.4%) 7 (8.3%) 0 (0.0%) 0.136 Target Lesion Retreatment, N (%) 1 (0.9%) 1 (1.2%) 0 (0.0%) 0.584 Clinical Follow-up Rate, n/N (%)‡ 134/142 (94.4%) 94/101 (93.1%) 40/41 (97.6%) 0.293 Preoperative NIHSS (Mean ± SD) 1.0 ± 2.9 1.1 ± 3.2 0.9 ± 1.5 0.667 Postoperative NIHSS (Mean ± SD) 0.4 ± 1.0 0.4 ± 1.0 0.5 ± 1.0 0.435 Follow-up mRS (Mean ± SD) 0.5 ± 1.2 0.5 ± 1.2 0.6 ± 1.3 0.643 Follow-up Period (Days, Mean ± SD) 535.1 ± 223.5 509.9 ± 220.3 619.3 ± 213.2 0.009 ** 30-Day Stroke Recurrence, N (%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 30-Day Mortality, N (%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1.000 TRA: transradial approach; TFA: transfemoral approach; NIHSS: National Institutes of Health Stroke Scale; mRS: Modified Rankin Scale; DSA: Digital Subtraction Angiography; CTA: Computed Tomography Angiography; MRA: Magnetic Resonance Angiography; ISR: in-stent restenosis. †109 of 152 lesions (71.7%) completed angiographic evaluation. ‡134 of 142 patients (94.3%) completed clinical follow-ups. *Statistical significance: *P < 0.05, **P < 0.01, ***P < 0.001. Table 4 Procedural Characteristics for ISR vs. Non-ISR Variable Non-ISR (N = 104) ISR (N = 5) Univariate P-value Multivariate Analysis Adjusted OR (95% CI) Multivariable P-value TRA, N (%) 81 (77.9%) 3 (60.0%) 0.323 Aortic Arch Type † 0.015 * - Type 1, N (%) 31 (39.7%) 0 (0.0%) Reference - - Type 2, N (%) 35 (44.9%) 4 (100.0%) 8.92 (2.11–37.72) 0.003 ** - Type 3, N (%) 12 (15.4%) 0 (0.0%) 1.04 (0.19–5.68) 0.964 Bovine Arch, N (%) † 8 (10.3%) 1 (25.0%) 0.378 Right Vertebral Artery Lesion, N (%) 65 (62.5%) 3 (60.0%) 1.000 Basilar Artery Stenosis, N (%) 5 (4.8%) 0 (0.0%) 1.000 Contralateral Vertebral Occlusion, N (%) 6 (5.8%) 0 (0.0%) 1.000 Contralateral Vertebral Stenosis/Hypoplasia, N (%) 28 (26.9%) 1 (20.0%) 1.000 Intracranial Vertebral Stenosis/Occlusion, N (%) 10 (9.6%) 0 (0.0%) 1.000 Lesion Length (mm, Mean ± SD) 6.7 ± 3.5 6.5 ± 2.6 0.929 Preoperative Stenosis (%, Mean ± SD) 62.3 ± 4.9% 74.1 ± 10.1% 0.003 ** 0.88 (0.81–0.96) 0.004 ** Residual Stenosis (%, Mean ± SD) 10.6 ± 10.6% 17.8 ± 11.1% 0.218 Stent Length (mm, Mean ± SD) 14.0 ± 2.9 12.8 ± 1.8 0.216 Stent Diameter (mm, Mean ± SD) 4.0 ± 0.9 4.1 ± 0.4 0.777 Maximal Inflation Pressure (atm, Mean ± SD) 11.0 ± 4.1 11.2 ± 2.7 0.898 ISR: in-stent stenosis; TRA: transradial approach. † Data available for 82/109 lesions (75.2%), with missing cases: 26 (Non-ISR) and 1 (ISR); *Statistical significance: *P < 0.05, **P < 0.01, ***P < 0.001. Table 5 Follow-up Results for ISR vs. Non-ISR Variable Non-ISR (N = 104) ISR (N = 5) Univariate P-value Multivariate Analysis Adjusted OR (95% CI) Multivariable P-value Follow-up Modality < 0.001 *** - DSA, N (%) 62 (59.6%) 5 (100.0%) Reference 0.005 ** - CTA/MRA, N (%) 42 (40.4%) 0 (0.0%) 0.12 (0.03–0.52) Follow-up Period (Days, Mean ± SD) 242.9 ± 147.2 311.8 ± 191.6 0.470 Follow-up Stenosis (%, Mean ± SD) 17.3 ± 12.7% 56.3 ± 8.7% < 0.001 *** 1.25 (1.12–1.40) < 0.001 *** Mild Intimal Hyperplasia, N (%) 23 (22.1%) 0 (0.0%) 0.582 Stent Fracture, N (%) 6 (5.8%) 1 (20.0%) 0.287 Target Lesion Retreatment, N (%) 0 (0.0%) 1 (20.0%) 0.046 * 12.5 (1.20–130.5) 0.035 * Preoperative NIHSS (Mean ± SD) 0.7 ± 1.4 0.8 ± 1.1 0.869 Postoperative NIHSS (Mean ± SD) 0.2 ± 0.7 0.2 ± 0.4 0.890 Follow-up mRS (Mean ± SD) 0.0 ± 0.0 0.5 ± 1.0 < 0.001 *** 0.15 (0.03–0.75) 0.021 * Follow-up Period (Days, Mean ± SD) 536.3 ± 219.6 692.2 ± 54.8 < 0.001 *** 1.01 (1.00–1.02) 0.067 30-Day Stroke Recurrence, N (%) 0 (0.0%) 0 (0.0%) - 30-Day Mortality, N (%) 0 (0.0%) 0 (0.0%) - ISR: in-stent stenosis; DSA: Digital Subtraction Angiography; CTA: Computed Tomography Angiography; MRA: Magnetic Resonance Angiography; NIHSS: National Institutes of Health Stroke Scale; mRS: Modified Rankin Scale. *Statistical significance: *P < 0.05, **P < 0.01, ***P < 0.001. Additional Declarations No competing interests reported. Supplementary Files TableS1.docx Cite Share Download PDF Status: Published Journal Publication published 14 Feb, 2026 Read the published version in Neuroradiology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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14:27:28","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":125610,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8165183/v1/79465b2c121f53a6834d2984.html"},{"id":97265577,"identity":"2de61188-91f9-4b9a-9bb9-c61347788c1c","added_by":"auto","created_at":"2025-12-02 14:27:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":728640,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT diagram. VAOS: vertebral artery ostial stenosis; TRA: transradial approach; TFA: transfemoral approach\u003c/p\u003e","description":"","filename":"Flowchart.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8165183/v1/cafc1df236c956eee9142781.jpg"},{"id":102785374,"identity":"198247c6-2ff9-4b9f-b746-aef9b4f591aa","added_by":"auto","created_at":"2026-02-16 16:05:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1918213,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8165183/v1/f5161338-b281-4945-a4b8-16831029276c.pdf"},{"id":97367259,"identity":"df3c9ef5-44ca-4fee-9d90-7e27702b35cd","added_by":"auto","created_at":"2025-12-03 16:17:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17297,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8165183/v1/6352b4d080b890625b9491dd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sirolimus Drug-Eluting Stent (DES) in Vertebral Artery Ostial Stenosis: Insights from a Multicenter Analysis","fulltext":[{"header":"Key Messages","content":"\u003cp\u003e\u003cstrong\u003e1. What is known:\u003c/strong\u003e Vertebral artery ostial stenosis is a common cause of posterior circulation stroke. Drug-eluting stents reduce in-stent restenosis in coronary applications, but data on their use in VAOS are limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. What this study adds:\u003c/strong\u003e Sirolimus DES are safe and effective for VAOS, with low ISR and no periprocedural complications. Both access routes are feasible, though anatomical factors predict ISR.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Clinical implications:\u003c/strong\u003e Sirolimus DES may be preferred for select VAOS patients. Recognizing ISR risk factors can inform access route and surveillance strategies.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eVertebral artery ostial stenosis (VAOS) contributes significantly to posterior circulation ischemic stroke, accounting for 20-25% of vertebrobasilar insufficiency cases[1, 2]. Despite optimal medical therapy, recurrent stroke remains frequent, with 5-year rates exceeding 30%[3]. Endovascular stenting has become a cornerstone for revascularization[4], yet in-stent restenosis (ISR) with bare-metal stents (BMS) remains a critical limitation, affecting 20–34% of treated lesions[5, 6].\u003c/p\u003e\n\u003cp\u003eDrug-eluting stents\u0026nbsp;(DES) offer targeted inhibition of neointimal proliferation and have transformed coronary interventions by reducing ISR to under 10%[7]\u003csup\u003e,\u003c/sup\u003e[8]. However, their role in extracranial vertebral arteries remains underexplored. The vertebral artery’s tortuous path[1]\u0026nbsp;and dynamic hemodynamic forces[9]\u0026nbsp;necessitate stents with high radial strength and flexibility—characteristics addressed by the Maurora sirolimus-DES (\u003cem\u003eAlain Medical, Beijing, PRC\u003c/em\u003e) constructed from cobalt-chromium alloy and coated with biodegradable sirolimus-polymer matrix[10].\u003c/p\u003e\n\u003cp\u003eWhile a few randomized trials / prospective studies in recent years had explored the use of DES for VAOS with some promising results, these are limited by modest sample sizes, restricted generalizability, and a lack of procedural variability seen in clinical practice.[7, 10] Comprehensive multicenter data on the sirolimus DES’s performance in VAOS are lacking. To date, only a handful of studies have evaluated sirolimus DES for VAOS specifically on access strategy, anatomical predictors, and ISR risk in a multicenter real-world setting. This study addresses that gap by offering pragmatic insights into DES implantation in VAOS, focusing on access strategies and anatomical factors associated with in-stent re-stenosis (ISR).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003ePatient\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSelection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis multicenter retrospective study was approved by the Institutional Review Boards of three participating hospitals, with written informed consent obtained from all patients. Between January 2022 and February 2024, we enrolled 142 consecutive patients diagnosed with vertebral artery ostial stenosis (VAOS) treated with sirolimus DES; see \u003cstrong\u003eFigure 1\u003c/strong\u003e. Clinical and procedural data were extracted from electronic medical records for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Age \u0026gt;18 years\u003c/p\u003e\n\u003cp\u003e2. Diagnosis of VAOS with either:\u003c/p\u003e\n\u003cp\u003e(a) Symptomatic stenosis \u0026ge;50% with ischemic stroke or TIA within the preceding 90 days, or\u003c/p\u003e\n\u003cp\u003e(b) Asymptomatic stenosis \u0026ge;70% confirmed by digital subtraction angiography (DSA)\u003c/p\u003e\n\u003cp\u003e3. Use of antiplatelet therapy (aspirin or clopidogrel/ticagrelor) prior to stenting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e Patients who underwent mechanical thrombectomy during the index procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEndovascular Procedure Algorithm and Treatment Protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDual antiplatelet therapy (DAPT) with aspirin 100 mg/day and either clopidogrel 75 mg/day or ticagrelor 90 mg twice daily was initiated \u0026ge;7 days pre-procedure and continued for \u0026ge;6 weeks post-stenting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll procedures were performed under local anesthesia by three dedicated neurointerventional teams from three centers having at least 10 years of continuous hands-on experience. Vascular access, either transradial (TRA) or transfemoral (TFA) approaches was selected at the operating team\u0026rsquo;s discretion based on anatomical suitability and experience. This non-randomized approach may introduce access-selection bias; thus, future studies should consider a \u003cstrong\u003estandardized protocol\u003c/strong\u003e or randomized design to reduce variability and improve reproducibility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSystemic heparinization was administered to maintain an activated clotting time of 250\u0026ndash;300 seconds. A 0.014-inch micro-guidewire was advanced through the lesion under fluoroscopic guidance, and Maurora sirolimus DES was deployed within the range of nominal and burst pressures for 15\u0026ndash;20 seconds in all cases. In cases with intraprocedural thrombotic complications, intravenous tirofiban was administered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-Up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAngiographic follow-up (DSA, computed tomography angiography [CTA], or magnetic resonance imaging angiography [MRA]) was scheduled at 3, 6, and 12 months. Clinical assessments included the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). ISR was defined as \u0026gt;50% luminal stenosis within or adjacent to the stent (5 mm margins)[11].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS version 26.0 (IBM Corp., USA). Continuous variables are expressed as mean \u0026plusmn; standard deviation (SD) and compared via Student\u0026rsquo;s t-tests. Categorical variables are reported as frequencies (%) and analyzed using \u0026chi;\u0026sup2; or Fisher\u0026rsquo;s exact tests. Multivariate logistic regression identified independent ISR predictors (p\u0026lt;0.05). Missing data, such as aortic arch type, were handled using multiple imputation.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Cohort \u0026amp; Baseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Differences between TRA and TFA patient groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 142 patients treated with sirolimus DES for 151 VAOS lesions (9 patients had bilateral VAOS lesions), baseline characteristics were generally well balanced between the TRA and TFA groups; see \u003cstrong\u003eTable 1\u003c/strong\u003e. No significant differences were observed in age (69.7 ± 7.3 years), sex distribution (86.6% male), or hypertension prevalence (76.1%). However, certain risk factors showed statistically significant variation:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eDiabetes mellitus was more prevalent in TRA patients (TRA 48.5% vs TFA 29.3%, p=0.041).\u003c/li\u003e\n \u003cli\u003eSmoking history was more prevalent in TFA patients (TFA 36.6% vs TRA 11.9%, p=0.001).\u003c/li\u003e\n \u003cli\u003eDyslipidemia (TFA 52.5% vs TRA 31.7%, p=0.027) and statin use (TFA 82.9% vs TRA 63.4%, p=0.027) were more frequent in the TFA cohort.\u003c/li\u003e\n \u003cli\u003ePrior PCI was notably more prevalent in the TRA group (TRA 17.8% vs. TFA 2.4%, p=0.026).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThese baseline imbalances likely reflect real-world access selection patterns based on operator discretion and patient comorbidities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Differences between patient groups with in-stent restenosis (ISR) and non-ISR on follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 109 lesions on follow-up (40 VAOS lesions were lost to follow-up), ISR occurred in 5 (4.6%) cases; see \u003cstrong\u003eTable S1\u003c/strong\u003e. Although higher body mass index (BMI) is more prevalent in these 5 post-stenting VAOS patients with ISR compared to non-ISR patients (25.1 ± 1.9 vs. 21.4 ± 7.8, p=0.007) with multivariate analysis hinting BMI as an independent predictor of ISR (adjusted OR 1.32; 95% CI 1.10–1.58; p=0.002), the limited positive ISR sample size (n=5) may have been underpowered, and findings should be interpreted with caution. No other baseline clinical variables including age, sex, diabetes, dyslipidemia, or antiplatelet/statin use differed significantly between these two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedural Characteristics (TRA versus TFA)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Differences between TRA and TFA patient groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProcedural metrics differed modestly between access routes (TRA in 110 cases and TFA in 41 cases); see \u003cstrong\u003eTable 2\u003c/strong\u003e. TFA was associated with the use of larger DES with diameter of 4.4 ± 0.7 mm and lower maximal inflation pressures of up to 9.9±4.2 atm, whereas TRA tend to use smaller-sized DES with diameter of 4.0±0.9 mm and higher maximal inflation pressures of up to 11.5 ± 3.7 atm (p=0.017 and p=0.022 respectively), suggesting access-specific biomechanical considerations. No significant differences were found in lesion length, baseline stenosis severity, or post-dilation frequency.\u003c/p\u003e\n\u003cp\u003eAnatomical features such as aortic arch configuration and vertebrobasilar anatomy were broadly comparable between groups, although Type II aortic arches were more frequently observed in TFA-treated lesions (TFA 58.3% vs TRA 39.4%), without reaching statistical significance (p=0.541). The frequency of intracranial atherosclerosis (ICAS) appeared higher in the TRA cohort (TRA 15.5% vs TFA 4.9%), with borderline significance (p=0.081), possibly reflecting selection bias.\u003c/p\u003e\n\u003cp\u003eNo significant neurologically disabling or life-threatening complications were reported in either group. Intraprocedural IV tirofiban use was more frequent in TFA group (TFA 4.9% vs TRA 0.0%, p=0.020), possibly reflecting higher perceived thrombotic risk. However, missing data on aortic arch type in 26.5% of lesions (particularly in TFA cases) may introduce information bias and limit definitive interpretation. Observed trends should be interpreted cautiously given the non-randomized design and potential for Type I error due to multiple testing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Procedural predictors of in-stent re-stenosis (ISR)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 109 sirolimus DES-treated VAOS lesions (26.5% lost to follow-up), multivariate analysis suggested type II aortic arch anatomy as a possible predictor of ISR (adjusted OR 8.92; 95% CI 2.11–37.72; p=0.003), with all ISR cases occurring exclusively in Type II aortic arches; see \u003cstrong\u003eTable 4\u003c/strong\u003e. Notably, aortic arch type data were missing in 25% of cases, which may introduce information bias. The small ISR sample (n=5) also limits the statistical power to detect modest associations and increases risk of Type II error. Thus, while the findings suggest anatomical and hemodynamic factors may contribute to ISR, these associations should be validated in larger prospective studies.\u003c/p\u003e\n\u003cp\u003eHigher baseline stenosis severity was also significantly associated with ISR (74.1±10.1% vs. non-ISR 62.3±4.9%, p=0.003) and remained significant in multivariable analysis (adjusted OR 0.88; 95% CI 0.81–0.96; p=0.004), indicating increased ISR risk with more severe pre-treatment narrowing. Other procedural variables including lesion length, stent diameter, inflation pressure, and contralateral VA pathology did not significantly differ between groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow-Up Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Differences between TRA and TFA patient groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e illustrated complete imaging follow-up in 109 of treated 151 VAOS lesions (72.2%), with a higher rate in TRA (76.4%) than TFA (61.0%) patient groups, though this did not reach statistical significance; p=0.061. Digital subtraction catheter angiography (DSA) was the predominant imaging modality in the TRA group (65.5%), while CTA (computed tomography angiogram) and/or MRA (magnetic resonance imaging angiography) was more frequently used in TFA cases (56.0%) with p=0.049, reflecting access-related surveillance practices. The mean angiographic follow-up duration did not differ significantly between groups.\u003c/p\u003e\n\u003cp\u003eThe overall ISR rate was low (5.5%) and similar between TRA (4.8%) and TFA (8.0%) groups (p=0.353). Mild intimal hyperplasia occurred in 21.1% of cases without group differences. Stent fracture was observed in 7 cases, all within the TRA cohort, though this trend did not reach significance (p=0.136). Only one patient in TRA group required target VAOS lesion re-intervention.\u003c/p\u003e\n\u003cp\u003eClinical follow-up was robust which 94.4% of patients were included, with comparable NIHSS and mRS scores between groups. TFA patients had a significantly longer mean clinical follow-up period (619.3±213.2 days vs. TRA 509.9±220.3 days; p=0.009), potentially influencing detection of late outcomes. No cases of 30-day stroke recurrence or mortality were reported in either cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. ISR vs. Non-ISR\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 109 DES-treated VAOS lesions with follow-up imaging, ISR cases exhibited markedly worse imaging and clinical outcomes; see \u003cstrong\u003eTable 5\u003c/strong\u003e. Follow-up stenosis severity was significantly higher in ISR lesions (56.3± 8.7% vs. non-ISR 17.3±12.7%; p\u0026lt;0.001) and remained an independent predictor of ISR in multivariate analysis (adjusted OR 1.25; 95% CI 1.12–1.40; p\u0026lt;0.001). All ISR cases were detected via DSA imaging, while non-ISR lesions were assessed using DSA or CTA/MRA (p\u0026lt;0.001), potentially reflecting differential surveillance intensity. Multivariate analysis confirmed that DSA imaging independently increased ISR detection likelihood (reference to CTA/MRA: OR 0.12; 95% CI 0.03–0.52; p=0.005). ISR was also associated with significantly higher rates of target lesion reintervention (20.0% vs. 0.0%; p=0.046; adjusted OR 12.5, 95% CI 1.20–130.5) and worse functional outcomes, as reflected by higher follow-up mRS scores (ISR 0.5±1.0 vs. non-ISR 0.0 ± 0.0; p\u0026lt;0.001; adjusted OR 0.15, 95% CI 0.03–0.75; P=0.021). No differences were noted in NIHSS scores or short-term clinical events, such as 30-day stroke recurrence or mortality. These findings underscore the clinical relevance of ISR, particularly its association with delayed stenotic progression, need for reintervention, and worse long-term disability despite the small ISR sample size (n=5), which may limit generalizability.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicenter retrospective study provides real-world insights into the efficacy, safety, and procedural nuances of sirolimus drug-eluting stent (DES) implantation for vertebral artery ostial stenosis (VAOS), with a comparative lens on transradial (TRA) versus transfemoral (TFA) approaches. The low overall in-stent restenosis (ISR) rate of 4.6% and absence of significant peri-procedural complications underscore the procedural safety and promising long-term patency of sirolimus DES in the extracranial vertebral circulation. The observed ISR rate of 4.6% marks a substantial improvement over historical benchmarks for bare-metal stents (BMS), which report ISR rates of 20.6-33.6%[5, 6]. This favorable outcome is consistent with the anti-proliferative effects of sirolimus, which suppress smooth muscle cell growth and neointimal hyperplasia which mechanisms as documented in coronary DES applications[12]. The performance of sirolimus DES in our cohort parallels findings from other DES studies in both coronary and cerebrovascular territories[8, 13, 14]. Our findings suggest that both TRA and TFA are feasible and safe access strategies for VAOS intervention. Despite minor differences in stent sizing and inflation pressure, TRA did not increase complication rates and offered comparable clinical and angiographic outcomes. The higher TFA follow-up duration may reflect access-related imaging preferences or selection bias. These results align with coronary data favoring TRA for procedural comfort and fewer access-site complications, although further prospective validation in neurovascular contexts is needed.\u003c/p\u003e\n\u003cp\u003eSeveral independent predictors of ISR in our study include high-grade baseline stenosis, higher body mass index, residual post-stent narrowing \u0026gt;15%, and notably, type II aortic arch anatomy which present in 100% of ISR cases. These findings may support the hypothesis that geometric complexity and altered shear stress may contribute to neointimal hyperplasia in vertebral stents.[13, 15] While causality cannot be confirmed, these associations may help refine procedural planning and risk stratification. While stent fractures were infrequent overall, they occurred in 20.0% of ISR lesions versus 5.8% of non-ISR lesions (p=0.287), a non-significant trend that may still carry biomechanical relevance. These findings suggest a multifactorial interplay involving stent material properties, lesion anatomy, and procedural technique[15, 16]. ISR was associated with significantly higher follow-up stenosis, worse mRS outcomes, and a 20% retreatment rate, highlighting its clinical burden even in a small sample. Interestingly, all ISR lesions were detected via DSA, reinforcing the need for high-fidelity imaging in long-term surveillance, particularly for patients with high-risk anatomy. The absence of early stroke recurrence or mortality supports sirolimus DES safety in both access routes, but the delayed functional impact of ISR warrants attention.\u003c/p\u003e\n\u003cp\u003eThis multicenter analysis adds valuable real-world evidence to the evolving landscape of endovascular treatment for VAOS. While prior studies on DES have been limited to single-center cohorts or small randomized trials, our study represents one of the largest multicenter evaluations of sirolimus DES performance in this anatomical context. The inclusion of anatomically diverse patients, variation in operator technique, and both TRA and TFA access routes enhance the external validity and generalizability of our findings. Importantly, the low ISR rate (4.6%) observed here not only supports prior reports on the efficacy of sirolimus DES in extracranial cerebrovascular applications but also establishes a benchmark for comparative studies against alternative modalities, such as drug-coated balloons (DCBs) with meta-analyses suggested ISR rates of 11.9%.[17] While DCB avoids permanent scaffold-related risks such as fracture and thrombosis[18] as well as reduces the need for prolonged dual antiplatelet therapy potentially lowering associated bleeding complications[19], our sirolimus DES-treated VAOS cohort may offer enhanced durability in anatomically complex or calcified VAOS lesions. As newer DES platforms including bioresorbable scaffolds and advanced polymer-drug systems are developed, comparative studies assessing efficacy, safety, and cost-effectiveness will be essential. Our findings establish a practical reference point for such comparisons and reinforce the potential of sirolimus DES as a first-line intervention for select VAOS patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIMITATIONS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study’s retrospective design introduces potential selection and information biases. Access route was operator-dependent, and data on arch anatomy was incomplete in 25% of cases. The small number of ISR events limits statistical power, and multivariate findings should be interpreted cautiously. Nonetheless, high follow-up rates and multicenter inclusion enhance generalizability, and our findings serve as a foundation for future prospective studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this multicenter retrospective analysis, sirolimus DES demonstrated favorable efficacy and safety for the treatment of VAOS, with a low in-stent restenosis rate and no periprocedural complications. Both transradial and transfemoral approaches were viable, though anatomical factors such as Type II aortic arch and baseline stenosis were significantly associated with restenosis. These findings contribute meaningful real-world evidence supporting the role of sirolimus DES in extracranial cerebrovascular interventions and highlight the need for individualized procedural strategies. Further prospective studies are warranted to validate ISR predictors and benchmark sirolimus DES against emerging revascularization technologies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDES\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDrug-eluting stent\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVAOS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVertebral artery ostial stenosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eISR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn-stent restenosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTRA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTransradial approach\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTFA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTransfemoral approach\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDigital subtraction angiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCTA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed tomography angiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMRA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic resonance angiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNIHSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Institutes of Health Stroke Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003emRS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eModified Rankin Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePercutaneous coronary intervention\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntracranial atherosclerosis\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDAPT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDual antiplatelet therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics and Consent to Participate declarations\u003c/h2\u003e\u003cp\u003eThis was a retrospective study. No human subjects, human material, or human data was involved so that the ethics committee approval was not required.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAcknowledgments： Conception and design: D.Z. and Y. F. Data acquisition: D.Z., B.L., and K.Z.. Analysis and interpretation of data: D.Z. and J.Z.. Critically revising the article: Y.F., S.Z.T. and X.L.. Y.F., S.Z.T. and X.L. reviewed the submitted manuscript. Approved the final version of the manuscript on behalf of all authors: Y.F., S.Z.T. and X.L.. Statistical analysis: D.Z., B.L., and K.Z.. Administrative/technical/material support: D.Z., S.Z.T..\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBurle VS, Panjwani A, Mandalaneni K, Kollu S, Gorantla VR (2022) Vertebral Artery Stenosis: A Narrative Review. 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J Stroke 21(1):101\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5853/jos.2018.00479\u003c/span\u003e\u003cspan address=\"10.5853/jos.2018.00479\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLim J, Baig AA, Aguirre AO, Cappuzzo JM, Vakharia K, Rho K, Waqas M, Monteiro A, Fretz TJ, Levy EI, Siddiqui AH (2024) Use of drug-eluting, balloon-expandable resolute onyx coronary stent as a novel treatment strategy for vertebral artery ostial stenosis: Case series. 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Comput Methods Biomech Biomed Engin 19(11):1190\u0026ndash;1200. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/10255842.2015.1123253\u003c/span\u003e\u003cspan address=\"10.1080/10255842.2015.1123253\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSi JH, Ma N, Gao F, Mo DP, Luo G, Miao ZR (2022) Effect of a Drug-Eluting Stent vs. Bare Metal Stent for the Treatment of Symptomatic Intracranial and Vertebral Artery Stenosis. 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Neuroradiology 49(3):253\u0026ndash;257. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00234-006-0185-x\u003c/span\u003e\u003cspan address=\"10.1007/s00234-006-0185-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu S, Yin Y, Li Z, Li N, Ma W, Zhang L (2023) Using drug-coated balloons for symptomatic vertebral artery origin stenosis: A systematic review and meta-Analysis. J Clin Neurosci 107:98\u0026ndash;105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jocn.2022.12.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jocn.2022.12.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Ma Y, Gao P, Chen Y, Yang B, Feng Y, Jiao L (2020) Paclitaxel Coated Balloon vs. Bare Metal Stent for Endovascular Treatment of Symptomatic Vertebral Artery Origin Stenosis Patients: Protocol for a Randomized Controlled Trial. Front Neurol 11:579238. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fneur.2020.579238\u003c/span\u003e\u003cspan address=\"10.3389/fneur.2020.579238\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGruber P, Berberat J, Kahles T, Anon J, Diepers M, Nedeltchev K, Remonda L (2020) Angioplasty Using Drug-Coated Balloons in Ostial Vertebral Artery Stenosis. Ann Vasc Surg 64:157\u0026ndash;162. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.avsg.2019.10.043\u003c/span\u003e\u003cspan address=\"10.1016/j.avsg.2019.10.043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003ePatient Baseline Characteristics for TRA vs. TFA\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eOverall\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;142)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eTRA\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;101)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eTFA\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;41)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMale Sex, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e123 (86.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e87 (86.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e36 (87.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eBMI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e21.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e20.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.889\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e69.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e69.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.931\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eHypertension, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e108 (76.1)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e76 (75.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e32 (78.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.830\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDiabetes, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e61 (43.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e49 (48.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (29.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.041\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eCoronary Artery Disease, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e22 (15.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e19 (18.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e3 (7.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.124\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eHyperhomocysteinemia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e43 (30.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e29 (28.7%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e14 (34.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.550\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDyslipidemia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e66 (46.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e53 (52.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e13 (31.7%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.027\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSmoking History, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e27 (19.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (11.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e15 (36.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePrior Radial PCI, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e19 (13.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e18 (17.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (2.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.026\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative Antiplatelet Use, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e99 (69.7%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e67 (66.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e32 (78.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.227\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative Statin Use, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e98 (69.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e64 (63.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e34 (82.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.027\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTIA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e48 (33.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e38 (37.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (24.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.171\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStroke, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e94 (66.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e63 (62.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e31 (75.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.154\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTRA: transradial approach; TFA: transfemoral approach. BMI: body mass index; PCI: percutaneous coronary intervention; TIA: transient ischemic attacks.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Statistical significance: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003eProcedural Characteristics for TRA vs. TFA\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eOverall\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;151\u003csup\u003e\u0026dagger;\u003c/sup\u003e)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eTRA\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;110)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eTFA\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;41)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAortic Arch Type\u0026Dagger;\u003c/div\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.541\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 1, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e45 (32.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e41 (41.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (33.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 2, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e46 (32.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e39 (39.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (58.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 3, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e20 (14.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e19 (19.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (8.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eBovine Arch Prevalence, N (%)\u0026Dagger;\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (8.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (10.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (16.7%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.621\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eRight Vertebral Artery Lesion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e91 (60.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e66 (60.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e25 (61.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.913\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eBasilar Artery Stenosis, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (4.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (4.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (4.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.931\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eContralateral Vertebral Occlusion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e11 (7.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (6.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (9.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.476\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eContralateral Vertebral Stenosis/Hypoplasia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e43 (28.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e32 (29.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e11 (26.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.784\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eIntracranial Vertebral Stenosis/Occlusion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e19 (12.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e17 (15.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (4.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.081\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eLesion Length (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e6.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.645\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e73.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e73.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e72.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.421\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eResidual Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e10.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e13.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.120\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Length (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.980\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Diameter (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.017\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMaximal Inflation Pressure (atm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e9.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.022\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePost-dilation, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e18 (11.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e13 (11.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (12.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.949\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eProcedure-related Complications, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eOther Complications, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTirofiban Use, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (1.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (4.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.020*\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTRA: transradial approach; TFA: transfemoral approach.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026dagger;N\u0026thinsp;=\u0026thinsp;151 lesions from 142 patients (9 bilateral cases, 6.3% of cohort).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026Dagger;Data available for 111/151 lesions (73.5%), with missing cases: 11 (TRA) and 29 (TFA).\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Statistical significance: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Results for TRA vs. TFA\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eOverall\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eTRA\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eTFA\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eImaging Follow-up Rate, n/N (%)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e109/151 (72.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e84/110(76.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e25/41 (61.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.061\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Modality\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.049\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- DSA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e66 (60.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e55 (65.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e11 (44.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- CTA/MRA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e43 (37.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e29 (32.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e14 (56.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Period (Days, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e244.2\u0026thinsp;\u0026plusmn;\u0026thinsp;147.6\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e240.7\u0026thinsp;\u0026plusmn;\u0026thinsp;133.8\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e264.2\u0026thinsp;\u0026plusmn;\u0026thinsp;194.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.576\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (0.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e21.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.478\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eISR, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e6 (5.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (4.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (8.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.353\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMild Intimal Hyperplasia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e23 (21.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e18 (21.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (20.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.878\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Fracture, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (6.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (8.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.136\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTarget Lesion Retreatment, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (0.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (1.2%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.584\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eClinical Follow-up Rate, n/N (%)\u0026Dagger;\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e134/142 (94.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e94/101 (93.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e40/41 (97.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.293\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative NIHSS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.667\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePostoperative NIHSS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.435\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up mRS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.643\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Period (Days, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e535.1\u0026thinsp;\u0026plusmn;\u0026thinsp;223.5\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e509.9\u0026thinsp;\u0026plusmn;\u0026thinsp;220.3\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e619.3\u0026thinsp;\u0026plusmn;\u0026thinsp;213.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.009\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e30-Day Stroke Recurrence, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e30-Day Mortality, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eTRA: transradial approach; TFA: transfemoral approach; NIHSS: National Institutes of Health Stroke Scale; mRS: Modified Rankin Scale; DSA: Digital Subtraction Angiography; CTA: Computed Tomography Angiography; MRA: Magnetic Resonance Angiography; ISR: in-stent restenosis.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026dagger;109 of 152 lesions (71.7%) completed angiographic evaluation.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026Dagger;134 of 142 patients (94.3%) completed clinical follow-ups.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Statistical significance: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003eProcedural Characteristics for ISR vs. Non-ISR\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eNon-ISR\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;104)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eISR\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eUnivariate\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eMultivariate Analysis\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eAdjusted OR (95% CI)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003eMultivariable\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTRA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e81 (77.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e3 (60.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.323\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAortic Arch Type\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.015\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 1, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e31 (39.7%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eReference\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 2, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e35 (44.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (100.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e8.92 (2.11\u0026ndash;37.72)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.003\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- Type 3, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (15.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.04 (0.19\u0026ndash;5.68)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.964\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eBovine Arch, N (%)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (10.3%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (25.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.378\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eRight Vertebral Artery Lesion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e65 (62.5%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e3 (60.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eBasilar Artery Stenosis, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (4.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eContralateral Vertebral Occlusion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e6 (5.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eContralateral Vertebral Stenosis/Hypoplasia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e28 (26.9%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (20.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eIntracranial Vertebral Stenosis/Occlusion, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (9.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.000\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eLesion Length (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e6.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.929\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e74.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.003\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.88 (0.81\u0026ndash;0.96)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.004\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eResidual Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.218\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Length (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.216\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Diameter (mm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.777\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMaximal Inflation Pressure (atm, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.898\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eISR: in-stent stenosis; TRA: transradial approach.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026dagger; Data available for 82/109 lesions (75.2%), with missing cases: 26 (Non-ISR) and 1 (ISR);\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Statistical significance: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Results for ISR vs. Non-ISR\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eNon-ISR\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;104)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eISR\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;5)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eUnivariate\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eMultivariate Analysis\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eAdjusted OR (95% CI)\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003eMultivariable\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Modality\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e***\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- DSA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e62 (59.6%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (100.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003eReference\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.005\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e**\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e- CTA/MRA, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e42 (40.4%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.12 (0.03\u0026ndash;0.52)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Period (Days, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e242.9\u0026thinsp;\u0026plusmn;\u0026thinsp;147.2\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e311.8\u0026thinsp;\u0026plusmn;\u0026thinsp;191.6\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.470\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Stenosis (%, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e17.3\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7%\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e***\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.25 (1.12\u0026ndash;1.40)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e***\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMild Intimal Hyperplasia, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e23 (22.1%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.582\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eStent Fracture, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e6 (5.8%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (20.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.287\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTarget Lesion Retreatment, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (20.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.046\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e12.5 (1.20\u0026ndash;130.5)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.035\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreoperative NIHSS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.869\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePostoperative NIHSS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.890\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up mRS (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e***\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.15 (0.03\u0026ndash;0.75)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.021\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e*\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFollow-up Period (Days, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e536.3\u0026thinsp;\u0026plusmn;\u0026thinsp;219.6\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e692.2\u0026thinsp;\u0026plusmn;\u0026thinsp;54.8\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e***\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cdiv class=\"SimplePara\"\u003e1.01 (1.00\u0026ndash;1.02)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cdiv class=\"SimplePara\"\u003e0.067\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e30-Day Stroke Recurrence, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e30-Day Mortality, N (%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eISR: in-stent stenosis; DSA: Digital Subtraction Angiography; CTA: Computed Tomography Angiography; MRA: Magnetic Resonance Angiography; NIHSS: National Institutes of Health Stroke Scale; mRS: Modified Rankin Scale.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Statistical significance: *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***P\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vertebral artery ostial stenosis, Sirolimus-eluting stent, Drug-eluting stent, In-stent restenosis, Transradial approach","lastPublishedDoi":"10.21203/rs.3.rs-8165183/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8165183/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Purpose\u003c/h2\u003e\u003cp\u003eVertebral artery ostial stenosis (VAOS) is a key contributor to posterior circulation ischemia. While drug-eluting stents (DES) have reduced restenosis rates in coronary applications, their efficacy in VAOS remains underexplored. This multicenter retrospective study evaluates the safety, efficacy, and restenosis predictors of sirolimus DES in VAOS, with comparison between transradial (TRA) and transfemoral (TFA) approaches.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eBetween January 2022 and February 2024, 142 patients (150 lesions) with symptomatic or severe asymptomatic VAOS were treated with sirolimus DES across three centers. Procedural data, follow-up imaging, and clinical outcomes were analyzed. In-stent restenosis (ISR) was defined as \u0026gt;\u0026thinsp;50% luminal narrowing within or adjacent to the stent.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe overall ISR rate was 4.6% (5/109 lesions). Independent predictors of ISR included higher baseline stenosis (OR 0.88; 95% CI 0.81\u0026ndash;0.96; P\u0026thinsp;=\u0026thinsp;0.004), Type II aortic arch (OR 8.92; 95% CI 2.11\u0026ndash;37.72; P\u0026thinsp;=\u0026thinsp;0.003), and higher BMI (OR 1.32; 95% CI 1.10\u0026ndash;1.58; P\u0026thinsp;=\u0026thinsp;0.002). No 30-day stroke or mortality events occurred. TRA and TFA had comparable ISR rates (4.8% vs. 8.0%; P\u0026thinsp;=\u0026thinsp;0.353), with TRA associated with higher inflation pressures and smaller stent diameters.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eSirolimus DES implantation for VAOS appears safe and effective, with low restenosis and no periprocedural adverse events. Anatomical factors, particularly aortic arch configuration, influence ISR risk. sirolimus DES represents a promising option for VAOS treatment, warranting further prospective validation.\u003c/p\u003e","manuscriptTitle":"Sirolimus Drug-Eluting Stent (DES) in Vertebral Artery Ostial Stenosis: Insights from a Multicenter Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:27:23","doi":"10.21203/rs.3.rs-8165183/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a889b83d-64b3-456f-97f9-ae069bb8a64f","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:02:56+00:00","versionOfRecord":{"articleIdentity":"rs-8165183","link":"https://doi.org/10.1007/s00234-026-03934-9","journal":{"identity":"neuroradiology","isVorOnly":false,"title":"Neuroradiology"},"publishedOn":"2026-02-14 15:58:27","publishedOnDateReadable":"February 14th, 2026"},"versionCreatedAt":"2025-12-02 14:27:23","video":"","vorDoi":"10.1007/s00234-026-03934-9","vorDoiUrl":"https://doi.org/10.1007/s00234-026-03934-9","workflowStages":[]},"version":"v1","identity":"rs-8165183","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8165183","identity":"rs-8165183","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}