Abstract
PurposeThe clinical significance of endovascular therapy in young patients with symptomatic intracranial atherosclerotic stenosis is not clear. We aimed to report our preliminary findings on the safety and effectiveness of a new endovascular treatment strategy, drug-coated balloon (DCB)-oriented angioplasty for young adults with severe symptomatic atherosclerotic middle cerebral artery (MCA) stenosis.MethodsWe retrospectively retrieved the data of seven young patients aged 21–32 years old with severe symptomatic atherosclerotic MCA stenosis treated with DCB-oriented angioplasty from January 2018 to October 2020. We collected clinical presentations, perioperative complications, and clinical and radiological outcomes.ResultsThe DCB was successfully dilated at the lesions in all seven patients and good antegrade perfusion was achieved in five. The other two patients underwent remedial stent implantation due to residual stenosis >50% and unstable antegrade perfusion after DCB dilatation. However, none of the patients had perioperative complications. There were no recurrent ischemic symptoms after a mean clinical follow-up period of 15.4 ± 6.9 months. Repeat vascular images of the patients showed no restenosis at 3- or 6-month imaging follow-up periods. High-resolution MRI (HRMRI) was completed in all the patients before the angioplasty procedure and at follow-up. Focal eccentric wall thickening was present at the site of stenosis preoperatively; however, the plaques had disappeared by the time of follow-up for all patients.ConclusionDCB-oriented angioplasty may be safe and effective for young patients with severe symptomatic atherosclerotic MCA stenosis.
Highlights
10–15% of ischemic strokes occur in young adults [1]
DCB-Oriented Angioplasty for Young Adults studies have shown that drug-coated balloons (DCB) are effective in preventing in-stent restenosis (ISR) [6], and preliminary data suggest that they are superior to stent implantation in the treatment of patients with symptomatic intracranial atherosclerotic stenosis (ICAS) [7]
Our study intends to explore the short-term clinical and imaging outcomes of DCB angioplasty in young patients with severe Middle cerebral artery (MCA) stenosis
Summary
10–15% of ischemic strokes occur in young adults [1]. Stroke due to early-onset atherosclerosis accounts for 20–25% [2], which is even higher in China. Middle cerebral artery (MCA) stenosis accounts for a high proportion of young patients with symptomatic intracranial atherosclerotic stenosis (ICAS) [3]. DCB-Oriented Angioplasty for Young Adults studies have shown that drug-coated balloons (DCB) are effective in preventing in-stent restenosis (ISR) [6], and preliminary data suggest that they are superior to stent implantation in the treatment of patients with symptomatic ICAS [7]. This new endovascular treatment strategy, DCBoriented angioplasty, might become an alternative treatment for intracranial atherosclerotic diseases [8]. Our study intends to explore the short-term clinical and imaging outcomes of DCB angioplasty in young patients with severe MCA stenosis
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