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Li B, Bian Q, Li H, He Y, Chen S, Zhang K, Wang Z. Effect of Drug-Coated Balloon Versus Stent Angioplasty in Patients With Symptomatic Intracranial Atherosclerotic Stenosis. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01176. [PMID: 38781497 DOI: 10.1227/ons.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Drug-coated balloons (DCBs) have exhibited promising results in coronary and peripheral artery diseases, but conclusive evidence is lacking in intracranial vasculature. We assessed the safety and efficacy of DCBs vs stent angioplasty for symptomatic intracranial atherosclerotic stenosis (sICAS) and initially identified patients who might have benefited most from DCB treatment. METHODS A single-center, retrospective cohort study was conducted from June 2021 to May 2022 with 154 patients with sICAS divided into 2 treatment groups: a DCB group (with or without remedial stenting, n = 47) and a stent group (n = 107). The treatment outcomes were compared using 1:2 propensity score matching. The primary safety end point was perioperative stroke or mortality, and the primary efficacy end point was the rate of target vessel restenosis at 12 months. The degree of luminal change was analyzed as a subgroup, defined as the difference between the degree of stenosis at follow-up and immediately after intervention. RESULTS One hundred eighteen patients were enrolled using propensity score matching, with 43 patients in the DCB group and 75 in the stent group. The incidence of perioperative adverse events was 2.3% in the DCB group and 8.0% in the stent group (P = .420). At a median follow-up of 12 months, the incidence of restenosis (11.9% [5/43] vs 28.0% [21/75], P = .045) and the median degree of stenosis (30% [20%, 44%] vs 30% [30%, 70%], P = .009, CI [0-0.01, 0.2]) were significantly lower in the DCB group than in the stent group. DCB angioplasty effectively prevented adverse events in the target vessel area and significantly reduced the degree of luminal change in the M1 segment of the middle cerebral artery (0 [0, 15%] vs 10% [0, 50%], P = .016). CONCLUSION DCB angioplasty might be a safe and effective alternative to stent angioplasty to treat sICAS, particularly among patients with M1 segment of the middle cerebral artery stenosis.
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Affiliation(s)
- Bei Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Qiang Bian
- Department of Pathophysiology, Weifang Medical University, Weifang, Shandong, P.R. China
| | - Heju Li
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Songtao Chen
- Cerebrovascular Department of Interventional Center, Henan University People's Hospital, Zhengzhou, Henan, P.R. China
| | - Kun Zhang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
| | - Ziliang Wang
- Cerebrovascular Department of Interventional Center, Henan Provincial People's Hospital, Zhengzhou, Henan, P.R. China
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Xue H, Xi J, Wu XF, Feng S, Wang J, Chen L. Evaluation of paclitaxel-coated balloon angioplasty for the treatment of symptomatic intracranial in-stent restenosis. Front Neurol 2024; 15:1360609. [PMID: 38841701 PMCID: PMC11150793 DOI: 10.3389/fneur.2024.1360609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Background Symptomatic intracranial in-stent restenosis (sISR) poses a major challenge in the management of cerebrovascular diseases, often requiring effective and safe treatment options. Objectives This study aims to evaluate the efficacy and safety of paclitaxel-coated balloon (PCB) angioplasty for treating sISR. Methods We conducted a retrospective analysis of five patients aged 49-74 years, who were treated with PCB angioplasty between January 2017 and June 2022. Treatment procedures included pre-operative digital subtraction angiography, antiplatelet therapy, and the use of the SeQuent Please balloon. Patients received aspirin and clopidogrel prior to and after the procedure. Results The procedure achieved a 100% success rate. The degree of ISR was significantly reduced from an average pre-operative rate of 72±18.9% to a post-operative rate of 34±8.22%. Long-term follow-up showed that the majority of patients did not experience restenosis, confirming the long-term effectiveness of the treatment. Conclusions PCB angioplasty demonstrates significant potential as an effective and safe treatment option for patients with sISR, especially those considered to be at high risk. This study supports further investigation into PCB angioplasty as a standard treatment for sISR.
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Affiliation(s)
| | | | | | | | | | - Liwei Chen
- Department of Neurology, Sanmenxia Hospital of the Yellow River, Sanmenxia, China
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Qiao H, Chang CH, Wang AYC, Li S, Yang W, Li G, Cen X, Wang R, Lin H. Safety and efficacy of drug coated balloon angioplasty for intracranial atherosclerotic disease. J Neurointerv Surg 2023; 15:e172-e177. [PMID: 36171100 DOI: 10.1136/jnis-2022-019122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drug coated balloon (DCB) angioplasty can provide sustained anti-restenotic efficacy without the limitations of permanent vascular implantation and is presumably ideal for treating intracranial atherosclerotic disease. However, the safety of paclitaxel in the neurovasculature remains a concern. METHODS 242 patients with angiographically verified symptomatic stenosis >70% in intracranial arteries treated with DCB angioplasty were reviewed divided into two groups: group A, patients with stenotic intracranial arteries; and group B, patients with acute, subacute, or chronic occluded intracranial arteries. The primary endpoint was any stroke or death within 30 days. The secondary endpoint was arterial restenosis of >50% during follow-up. RESULTS 16 major and 12 minor complications occurred among 245 procedures (6.5% and 4.9%, respectively). Five patients died within 30 days after the procedure (2.1%, 5/242). 12 major and 12 minor complications occurred among 211 procedures in group A (5.7% and 5.7%). In group B, four major complications occurred among 34 procedures (11.8%). Hyperperfusion and perforator stroke accounted for half of all complications (53.6%, 15/28). Restenosis >50% was present in eight lesions during the follow-up period (4.8%, 8/167). CONCLUSIONS After treatment with DCB angioplasty, complications were no different from those after standard balloon angioplasty or stenting. This study suggests that DCB angioplasty may be a safe and effective procedure for intracranial arterial stenosis.
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Affiliation(s)
- Hanzi Qiao
- Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Chien-Hung Chang
- Neurology, Chang Gung Memorial Hospital Linkou Branch, Gueishan, Taoyuan, Taiwan
| | - Alvin Yi-Chou Wang
- Department of Neurosurgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Shaoxue Li
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weilin Yang
- Brain Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Guoming Li
- Neurology Department, Second Clinical Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuecheng Cen
- Neurosurgical Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Rongfei Wang
- Department of Neurology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Hao Lin
- Neurological Department, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
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Wang T, Yang K, Zhang X, Luo J, Xu R, Wang X, Yang Y, Bai X, Ma Y, Yan Y, Jiao L. Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis. Transl Stroke Res 2022; 13:676-685. [PMID: 35150413 DOI: 10.1007/s12975-022-00996-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/19/2022]
Abstract
Intracranial artery atherosclerotic stenosis (ICAS) is one of the most common causes of stroke. Endovascular therapy including balloon angioplasty alone (BA), balloon-mounted stent (BMS), or self-expanding stent (SES) was an important alternative to treat symptomatic ICAS refractory to medical treatment, while none of the three subtypes has been established to be the primary option. We conducted a systematic review and network meta-analysis to determine both the safety and efficacy and establish a hierarchy of different endovascular therapies on symptomatic ICAS. Major databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies comparing outcomes of three different endovascular approaches and other comparable non-endovascular therapies for symptomatic ICAS patients published from 1 January 2000 to 1 November 2021. Primary outcomes included short-term mortality or stroke rate (peri-procedural, or mean follow-up ≤ 3 months), and long-term mortality or stroke rate (mean follow-up ≥ 6 months). Pairwise and network meta-analyses based on the above systematic review were conducted. A total of 19 eligible studies involving 3386 patients treated with 4 different approaches (BA, SES, BMS, and medical treatment) were analyzed. For primary outcome, BA had the highest ranking (SUCRA value 78), followed by BMS (SUCRA value 21.5) and SES (SUCRA value 13.1). The short-term mortality or stroke rate was significantly lower in the BA group compared to SES (OR = 2.50; 95% CI 1.12 to 5.57; p = 0.026) or BMS (OR = 0.43; 95% CI 0.19 to 0.96; p = 0.038). Other primary and secondary outcomes were no different among all three types of endovascular therapy. Overall, the studies were of good methodological quality and the consistency was acceptable across all network meta-analyses. BA offers the highest level of safety outcomes in terms of short-term mortality or stroke in treating symptomatic patients with intracranial artery stenosis, compared to SES and BMS, which needs to be confirmed in future studies. Trial registration in PROSPERO database: CRD42018084055.
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Affiliation(s)
- Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yutong Yang
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China.
- China International Neuroscience Institute (China-INI), Beijing, 100053, China.
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China.
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100053, China.
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China.
- China International Neuroscience Institute (China-INI), Beijing, 100053, China.
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
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A retrospective study of drug-coated balloon angioplasty for vertebral artery origin stenosis. Neuroradiology 2022; 64:1617-1625. [PMID: 35257205 DOI: 10.1007/s00234-022-02926-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Angioplasty using drug-coated balloon (DCB) for treatment of symptomatic vertebral artery origin stenosis (VAOS) is promising, but of uncertain benefit. This study aimed to evaluate the feasibility, safety, and effectiveness of using DCB in the treatment of severe VAOS. METHODS This study included 20 patients with severe VAOS treated with DCB alone between April 2018 and December 2019. Vascular death, transient ischemic attack (TIA), and stroke related to the responsible artery within 30 days after procedure were recorded as primary endpoints. Restenosis, late TIA, and stroke related to VAOS and satisfied clinical outcome [modified Rankin Scale (mRS) ≤ 2] were documented at follow-up visit as secondary endpoints. RESULTS Of 20 patients, 16 were performed DCB dilation successfully, and 4 were excluded due to further bailout stenting. After the procedure, no adverse event occurred within 30 days. Ten of 16 patients achieved residual VAOS (rVAOS) < 50% (lower rVAOS group), and the remaining 6 patients achieved rVAOS ≥ 50% but < 70% (higher rVAOS group). During follow-up, vertebral artery origin restenosis was detected in 3 (18.8%) of 16 patients by ultrasound. Among the 3 patients with restenosis, 2 were belonged to the higher rVAOS group, which might indicate a tendency that the more severe the residual stenosis, the higher the restenosis rate. All patients had no complaint in the whole follow-up period (median, 7 months; InterQuartile Range, 1-18 months). CONCLUSIONS Angioplasty using DCB for VAOS may be feasible, safe, and effective. The degree of residual stenosis after using DCB alone may affect the restenosis rate.
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Li G, Qiao H, Lin H, Wang R, Chen F, Li S, Yang W, Yin L, Cen X, Zhang Y, Cheng X, Wang AYC. Application of drug-coated balloons for intracranial atherosclerosis disease: a systematic review. Clin Neurol Neurosurg 2021; 213:107065. [PMID: 34991058 DOI: 10.1016/j.clineuro.2021.107065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although percutaneous transluminal angioplasty and stenting (PTAS) was an effective and safe alternative treatment for severe intracranial atherosclerosis disease (ICAD), the high rate of restenosis remained a major issue for this endovascular procedure. Recently, the application of drug-coated balloons (DCB) in ICAD was developed to reduce restenosis. This systematic review aimed to evaluate the efficacy and safety of DCB angioplasty for ICAD. METHODS We searched relevant databases for eligible studies enrolling ICAD patients treated with DCB. The event rates of restenosis and periprocedural complications in the follow-up period were pooled with random-/fixed-effect models using Freeman-Tukey double arcsine transformation. Heterogeneity tests and publication bias tests were performed. RESULTS Two hundred and twenty-four ICAD patients treated with DCB from 9 eligible studies were included. Rate of stenosis in the DCB arm before treatment was ranged from 62% to 90% and reported median follow-up was ranged from 3 to 10.7 months. The pooled incidence of restenosis were 5.7% (95% confidence interval [CI] 2.6%-9.7%; I2 = 0%, p = 0.516) and 5.9% for periprocedural complications (95% CI: 2.5-10.3%; I2 = 0%, p = 0.649) in follow-up term. CONCLUSION With the limitation of the low quality of the available evidence, angioplasty with DCB appears to be effective and safe in severe ICAD. Further larger randomized trials are needed to provide more definitive evidence and to address the ideal clinical context for their application.
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Affiliation(s)
- Guoming Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hanzi Qiao
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Hao Lin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Rongfei Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Fajun Chen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Shaoxue Li
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Weilin Yang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Lei Yin
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xuecheng Cen
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Yingguang Zhang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
| | - Xiao Cheng
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China; Guangdong Provincial Chinese Emergency Key Laboratory, Guangzhou 510120, China; Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510006, China.
| | - Alvin Yi-Chou Wang
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Dade Road No.111, Guangzhou, Guangdong 510120, China.
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Zhang K, Xia JC, Gao HL, Gao BL, Wang YF, Li ZS, Li TX, Wang ZL. Case Report: Double Micro-Guidewire Technique for Emergent Rescue of Proximal Stent Collapse During Recanalization of Nonacute Occlusion of Vertebral Artery. Front Neurol 2021; 12:671158. [PMID: 34539544 PMCID: PMC8446545 DOI: 10.3389/fneur.2021.671158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022] Open
Abstract
Cerebral arteries are usually tortuous, and in the treatment of cerebrovascular diseases with stenting, a stent deployed may be collapsed at one end, leading to reduced blood flow and subsequent stent occlusion. Immediate rescuing measures should be implemented to prevent severe ischemic events. In this case report, we present a case with V4 segment occlusion of the right vertebral artery treated with endovascular stent angioplasty. An Enterprise stent deployed at the occlusion segment was collapsed at the proximal end after withdrawal of the delivery system. Immediate rescuing measures were taken by navigating a micro-guidewire through the lateral stent mesh at the proximal end into the stent lumen followed by advancing a second micro-guidewire right through the reopened proximal stent end into the stent lumen for deployment of a supporting balloon-expandable Apollo stent to prevent stent collapse. Follow-up digital subtraction angiography 6 months later demonstrated patent stents and unobstructed blood flow.
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Affiliation(s)
- Kun Zhang
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Jin-Chao Xia
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hui-Li Gao
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Bu-Lang Gao
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Yong-Feng Wang
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhao-Shuo Li
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Tian-Xiao Li
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zi-Liang Wang
- Henan Provincial Hospital of Cerebrovascular Diseases, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
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