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

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Abstract

Purpose

Intracranial atherosclerosis disease (ICAD) is an essential cause of stroke. The characteristics of effective treatment include low periprocedural risk and a sustained treatment effect. Angioplasty with a conventional balloon for ICAD is safe but has a dauntingly high restenosis rate. Drug-coated balloon (DCB) angioplasty might reduce the risk of restenosis while maintaining the overall safety of the procedure.

Methods

This study included symptomatic ICAD patients with more than 70% stenosis. Intermediate catheters were placed distally, and the lesions were predilated with a conventional balloon, followed by a DCB (SeQuent Please, B Braun, Melsungen, Germany). The primary endpoint was any stroke or death within 30 days or ipsilateral ischemic stroke thereafter. The secondary endpoint was arterial restenosis of more than 50% during follow-up.

Results

A total of 39 sessions of DCB angioplasty were performed for 39 lesions in 35 patients between October 2015 and April 2018 in a single 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 3 lesions during the follow-up period (8.3%, 3/36).

Conclusion

In this study, the application of DCBs to treat ICAD patients was feasible and safe. A larger scale clinical trial is warranted to further evaluate the safety and efficacy of this treatment.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, 510120, Guangzhou, Guangdong, China

    Alvin Yi-Chou Wang

  2. Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China

    Chien-Hung Chang & Chuan-Min Lin

  3. Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China

    Ching-Chang Chen, Chun-Ting Chen & Po-Chuan Hsieh

  4. Department of Medical imaging and intervention, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan, China

    Yi-Ming Wu

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  1. Alvin Yi-Chou Wang
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Contributions

AY Wang and CH Chang wrote the original draft, with equal contributions and both as first authors. All other authors reviewed and provided meaningful feedback in the creation of the final draft. All authors approved the final draft.

Corresponding author

Correspondence to Alvin Yi-Chou Wang.

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Conflict of interest

A.Y.-C. Wang, C.-H. Chang, C.-C. Chen, Y.‑M. Wu, C.-M. Lin, C.-T. Chen and P.-C. Hsieh declare that they have no competing interests.

Additional information

Alvin Yi-Chou Wang and Chien-Hung Chang contributed equally to this work.

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Wang, A.YC., Chang, CH., Chen, CC. et al. Leave Nothing Behind: Treatment of Intracranial Atherosclerotic Disease with Drug-Coated Balloon Angioplasty. Clin Neuroradiol 31, 35–44 (2021). https://doi.org/10.1007/s00062-020-00935-w

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  • DOI: https://doi.org/10.1007/s00062-020-00935-w

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