Leave Nothing Behind: Treatment of Intracranial Atherosclerotic Disease with Drug-Coated Balloon Angioplasty.

Abstract

Intracranial atherosclerosis disease (ICAD) is an essential cause of stroke. The characteristics of effective treatment include low periprocedural risk and asustained treatment effect. Angioplasty with aconventional balloon for ICAD is safe but has adauntingly high restenosis rate. Drug-coated balloon (DCB) angioplasty might reduce the risk of restenosis while maintaining the overall safety of the procedure. This study included symptomatic ICAD patients with more than 70% stenosis. Intermediate catheters were placed distally, and the lesions were predilated with aconventional balloon, followed by aDCB (SeQuent Please, BBraun, Melsungen, Germany). The primary endpoint was any stroke or death within 30days or ipsilateral ischemic stroke thereafter. The secondary endpoint was arterial restenosis of more than 50% during follow-up. Atotal of 39sessions of DCB angioplasty were performed for 39lesions in 35patients between October 2015 and April 2018 in asingle center. All of the DCBs could be navigated to the lesions. Major periprocedural complications were noted in two patients (5.7%, 2/35), and minor periprocedural complications were also noted in two patients (5.7%, 2/35). The average percentages of stenosis of the lesions were 76.6% ± 7% before treatment, 32.4% ± 11.2% after DCB angioplasty, and 25% ± 16% at follow-up. Stenosis over 50% was present in 3lesions during the follow-up period (8.3%, 3/36). In this study, the application of DCBs to treat ICAD patients was feasible and safe. Alarger scale clinical trial is warranted to further evaluate the safety and efficacy of this treatment.