Scientiﬁc, Maple Grove, MN, USA). Stents were placed in the following locations: 3 intracranial ICA, 2 middle cerebral, 2 basilar, and 1 vertebral artery stenosis. Patients had a signiﬁcant reduction in the initial stenosis (84% to 2.5%). One patient had a retinal embolism during guide catheter removal and there was a post-stenting, nonﬂow-limiting, asymptomatic basilar artery dissection, which healed spon- taneously during the follow-up period. No recurrence of cerebral ischemic events was observed during the follow-up period (mean 11.1 months). None of the angiographically studied patients (n = 5 of 8) developed signiﬁcant restenosis, and none required target vessel revascularization (Abou- Chebl et al 2005). In their retrospective analysis of patients treated with DES for both extra- and intracranial lesions, Gupta and col- leagues (2006) described 29 intracranial cases treated with either Cypher® or Taxus® stents. In 19 cases, the lesions were in the intracranial vertebral or basilar artery, while the remaining 10 were in the intracranial ICA. Technically suc- cessful stent implantation was achieved in 90% (26/29) of cases: the stent could not be deployed in 2 intracranial ICAs and 1 vertebral. Two peri-procedural complications were observed: 1 non-ﬂow limiting dissection in an intracranial ICA and 1 disabling stroke 12 hours after placement of a basilar artery stent. There were no new restenotic lesions seen in 20 stents that were followed with repeat angiography or computed tomography at least 3 months after implantation (Gupta et al 2006). Qureshi and colleagues (2006) retrospectively analysed 18 patients stented with DES for symptomatic lesions located in the intracranial ICA (6), the proximal middle cerebral artery (4), the vertebral artery (4), the vertebrobasilar junc- tion (2), or the basilar artery (2). A Cypher® stent was used in 14 cases and the remaining 4 received Taxus® stents. It was attempted to perform stenting in 3 more patients, but the procedure was unsuccessful, resulting in technical success rate of 85.7%. During the ﬁrst month after the intervention, no patients died and 1 patient experienced a major stroke. Cerebral angiography was performed in 7 patients at 6 months follow-up and revealed a binary restenosis rate of 14% (Qureshi et al 2006). In our service, we performed a single Cypher® DES implantation in a 63-years old female patient presenting with a symptomatic high-grade stenosis situated in the intracranial segment of the ICA. Primary stenting was performed using a 3.5 mm diameter stent of 33 mm in length. The procedure was successfully completed without residual stenosis, or clinical complaints. To date, 2 years after the intervention, Vascular Health and Risk Management 2008:4(3) DES in the management of PAD the patient is alive and has not experienced any further neurological events. Discussion At present, DES exist only on a balloon-mounted platform, which is expensive and potentially prone to crush injury. The expected superiority of DES for infrapopliteal and intracranial interventions in comparison to BMS is theoreti- cal at present and extrapolated from outcomes seen in the coronary literature (Holmes et al 2004; Stone et al 2004). The need for performance of randomized controlled trials cannot be emphasized enough. The treatment of CLI, is one indication where use of DES may have a major impact. If treated strictly medically, only 50% of the patients with CLI will be alive without a major amputation after 1 year. Approximately 25% will have died and 25% will have had a major amputation (Norgren et al 2007; Siablis et al 2007). These patients lack conduit, have unsuitable target vessels for revascularization and signiﬁcant comorbidities that pre- clude open surgical intervention. The paradigm has shifted to minimally invasive revascularization using PTA and stent- ing, but, although this approach has modiﬁed outcomes, the present 30%–50% restenosis rate at one year after PTA and implantation of BMS in the below-knee location warrants further improvement (Siablis et al 2005; Scheinert et al 2005; Commeau et al 2006). There is also deﬁnitely room for improvement in the intracranial circulation. The compelling stroke rate seen in the WASID study, where patients with greater than 70% intra- cranial stenosis treated medically had a 23% stroke rate at one year, and, the 35% documented angiographic restenosis seen in the SSYLVIA trial, where the bare metal, balloon- expandable Neurolink® stent (Advanced Cardiovascular Inc., Guidant, Indianapolis, IN) was implanted, both highlight the limitations of existing treatment strategies (SSYLVIA Investigators 2004; Chimowitz et al 2005). Despite the high angiographic restenosis rate seen after BMS implantion in the SSYLVIA trial, only 40% of these restenosis led to neurologic complaints. It is therefore unclear, whether the potential for symptomatic restenosis reduction that might be provided with DES implants in this location outweighs the risk of early thombotic occlusion attributed to DES. The initial enthusiasm for DES stems from their efﬁcacy in reducing in-stent restenosis and neointimal hyperplasia from 30% to approximately 5% (Holmes et al 2004; Stone et al 2004). Although direct arterial toxicity from the eluted drugs is unfounded, there are late thromboses secondary to delayed endothelialization that necessitate prolonged 557