Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
J Neurointerv Surg. 2019 Jun;11(6):569-573. doi: 10.1136/neurintsurg-2018-014237. Epub 2018 Oct 18.
The optimal treatment for patients with symptomatic severe intracranial atherosclerotic disease is not well established. Angioplasty and stenting have been attempted, with controversial results, mainly attributed to perioperative complications and a high incidence of restenosis or in-stent restenosis. Drug-coated balloons (DCBs) have shown encouraging results for coronary and peripheral artery disease, without convincing data for intracranial vasculature.
To assess the feasibility, clinical and angiographic outcomes of DCBs for patients with intracranial de novo atherosclerotic disease.
Between September 2016 and September 2017, details of 30 patients with 31 arteries treated with DCBs for symptomatic severe intracranial atherosclerotic disease (≥70% stenosis or chronic total occlusion) were retrospectively collected in our centre. All lesions were predilated with conventional balloons. Periprocedural complications and clinical and vascular imaging follow-up outcomes were analysed.
All arteries were successfully dilated with DCBs and 29 (93.5%) arteries achieved good antegrade perfusion, with remedial stenting for two arteries. Two patients presented with new ischemic stroke after the procedure. Over a mean follow-up of 9.8±2.6 months, no patient had recurrent ischemic symptoms. Repeat vascular imaging was performed at 7.0±1.1 months, with cerebral angiography in 24 patients (25 arteries) and MR angiography in six patients (six arteries). Only one (3.2%) artery presented with angiographic asymptomatic restenosis.
This study suggests that DCB dilatation may be a safe and effective alternative for intracranial de novo atherosclerotic disease.
症状性严重颅内动脉粥样硬化疾病患者的最佳治疗方法尚未确定。血管成形术和支架置入术已被尝试应用，但结果存在争议，主要归因于围手术期并发症和再狭窄或支架内再狭窄的发生率较高。药物涂层球囊（DCB）在冠状动脉和外周动脉疾病方面显示出令人鼓舞的结果，但对于颅内血管尚无令人信服的数据。
评估 DCB 治疗颅内新发性动脉粥样硬化疾病患者的可行性、临床和血管造影结果。
在 2016 年 9 月至 2017 年 9 月期间，我们中心回顾性收集了 30 例 31 条动脉接受 DCB 治疗症状性严重颅内动脉粥样硬化疾病（≥70%狭窄或慢性完全闭塞）患者的详细资料。所有病变均先用传统球囊预扩张。分析围手术期并发症以及临床和血管成像随访结果。
所有动脉均成功用 DCB 扩张，29 条（93.5%）动脉实现了良好的前向灌注，两条动脉需要补救性支架置入。术后有 2 例患者出现新的缺血性卒中。平均 9.8±2.6 个月的随访期间，无患者出现复发性缺血症状。在 7.0±1.1 个月时进行了重复血管成像，24 例患者（25 条动脉）进行了脑血管造影，6 例患者（6 条动脉）进行了磁共振血管造影。仅 1 条（3.2%）动脉出现无症状性再狭窄。
本研究表明，DCB 扩张可能是颅内新发性动脉粥样硬化疾病的一种安全有效的治疗选择。
