Klinik für Neuroradiologie, Bürgerhospital, Klinikum Stuttgart, Germany.
AJNR Am J Neuroradiol. 2011 Nov-Dec;32(10):1942-7. doi: 10.3174/ajnr.A2644. Epub 2011 Sep 1.
ISRs remain a major issue in the endovascular management of ICAD, requiring retreatment by reangioplasty. The aim of the present study was to evaluate the technical feasibility, safety, and efficiency of the novel DEBs for neurovascular ISRs.
Fifty-one patients (median age, 67 years; age range, 34-82 years; male/female ratio, 37:14) underwent 63 balloon dilation procedures for ISRs in intracranial stented arterial segments between November 2007 and August 2010 in a single center. Of the 63 procedures, 20 (32%) were performed by using a conventional balloon and 43 (68%), by using a paclitaxel-eluting balloon (SeQuent Please). Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of a recurrent ISR after reangioplasty were analyzed.
Technical success, defined as <50% residual stenosis was achieved in all cases (100%), with failure of the DEB treatment in 6% of the attempts; those lesions were finally successfully treated with a conventional balloon. The combined permanent neurologic morbidity and mortality rate (stroke, ICH, and SAH) at 30 days was 1.6%. Substantial difference was found in the rate of recurrent stenosis when comparing conventional balloons and DEBs, with recurrent stenosis rates of 50% and 9%, respectively.
The initial results of reangioplasty of intracranial ISRs with DEBs are encouraging; further technical developments are, nevertheless, mandatory.
支架内再狭窄（ISR）仍是血管内治疗颅内动脉狭窄（ICAD）的主要问题，需要通过再次血管成形术进行治疗。本研究旨在评估新型药物洗脱球囊（DEB）治疗神经血管 ISR 的技术可行性、安全性和有效性。
2007 年 11 月至 2010 年 8 月，在一家中心，51 例患者（中位年龄 67 岁，年龄范围 34-82 岁；男/女比例 37:14）接受了 63 次颅内支架段血管内 ISR 的球囊扩张术。63 次手术中，20 次（32%）采用传统球囊，43 次（68%）采用紫杉醇洗脱球囊（SeQuent Please）。在 6 周和 12 周、6 个月和 12 个月以及此后每年进行血管造影和临床随访。分析了技术成功率、围手术期并发症、复发性缺血症状的发生情况以及再次血管成形术后再发 ISR 的情况。
所有病例均达到<50%残余狭窄的技术成功标准（100%），其中 6%的尝试失败，这些病变最终采用传统球囊成功治疗。30 天内联合永久性神经功能障碍和死亡率（卒中和 ICH 和 SAH）为 1.6%。与传统球囊相比，DEB 治疗的再狭窄率有显著差异，分别为 50%和 9%。
用 DEB 对颅内 ISR 进行再次血管成形术的初步结果令人鼓舞，但仍需要进一步的技术发展。
