Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
Neurosurgery. 2020 Oct 15;87(5):992-998. doi: 10.1093/neuros/nyaa191.
Conventional stent-based angioplasty was challenged for the high incidence of perioperative complications and follow-up in-stent restenosis (ISR) in treating intracranial atherosclerotic disease (ICAD). Currently, the drug-coated balloon (DCB) has shown promise in preventing and treating ISR.
To compare the efficacy and safety of DCB dilation (with or without stenting) with conventionally only stenting angioplasty for symptomatic ICAD in routine clinical practice.
From January 2016 to January 2019, consecutive patients treated with endovascular therapy for symptomatic ICAD were identified and dichotomized by whether DCB was used. The efficacy and safety endpoints, including periprocedural complications, clinical, and imaging follow-up outcomes between the 2 groups, were compared by propensity score matching.
A total of 42 patients in the DCB group and 73 patients in the non-DCB group were enrolled. Propensity score matching analysis selected 76 matched patients. Angiographic follow-up was completed at 185 ± 33 d. The median stenosis degree (0 [0%-20.0%] vs 15.0 [0%-62.5%], P = .005) and total restenosis incidence (5.3% [2/38] vs 34.2% [13/38], P = .003) in the DCB group were significantly lower than those in the non-DCB group. The periprocedural complications (2.6% vs 10.5%, P = .375), recurrent ischemic events (2.6% vs 13.2%, P = .219), and symptomatic restenosis (2.6% vs 10.5%, P = .375) were not statistically different between the 2 groups.
Compared with conventionally only stenting angioplasty, DCB dilation can effectively lower restenosis degree and total restenosis risk, with no superiority in symptomatic restenosis at 6-mo follow-up.
传统的支架血管成形术在治疗颅内动脉粥样硬化性疾病（ICAD）时，存在围手术期并发症发生率高和支架内再狭窄（ISR）的后续问题，因此受到挑战。目前，药物涂层球囊（DCB）在预防和治疗 ISR 方面显示出了良好的效果。
比较在常规临床实践中，药物涂层球囊扩张（有或无支架置入）与单纯支架血管成形术治疗有症状的 ICAD 的疗效和安全性。
从 2016 年 1 月至 2019 年 1 月，连续入选接受血管内治疗的有症状的 ICAD 患者，根据是否使用 DCB 将其分为两组。通过倾向性评分匹配比较两组患者的围手术期并发症、临床和影像学随访结果等疗效和安全性终点。
DCB 组共纳入 42 例患者，非-DCB 组共纳入 73 例患者。通过倾向性评分匹配选择了 76 例匹配患者。血管造影随访完成于 185±33d。DCB 组的狭窄程度中位数（0[0%-20.0%]比非-DCB 组的 15.0[0%-62.5%]，P=0.005）和总的再狭窄发生率（5.3%[2/38]比非-DCB 组的 34.2%[13/38]，P=0.003）明显低于非-DCB 组。两组围手术期并发症发生率（2.6%比 10.5%，P=0.375）、复发性缺血事件发生率（2.6%比 13.2%，P=0.219）和有症状的再狭窄发生率（2.6%比 10.5%，P=0.375）无统计学差异。
与单纯支架血管成形术相比，DCB 扩张术可有效降低再狭窄程度和再狭窄总发生率，但在 6 个月随访时，症状性再狭窄发生率无优势。
