RT Journal Article
SR Electronic
T1 Neurovascular In-Stent Stenoses: Treatment with Conventional and Drug-Eluting Balloons
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1942
OP 1947
DO 10.3174/ajnr.A2644
VO 32
IS 10
A1 Z. Vajda
A1 T. Güthe
A1 M. Aguilar Perez
A1 A. Heuschmid
A1 E. Schmid
A1 H. Bäzner
A1 H. Henkes
YR 2011
UL http://www.ajnr.org/content/32/10/1942.abstract
AB BACKGROUND AND PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: The initial results of reangioplasty of intracranial ISRs with DEBs are encouraging; further technical developments are, nevertheless, mandatory. ASAacetylsalicylic acidDEBdrug-eluting balloonDESdrug-eluting coronary stentDSAdigital subtraction angiographyIAintra-arterialICADintracranial atherosclerotic diseaseICHintracranial hemorrhageISRin-stent recurrent stenotic lesionIVintravenousMCAmiddle cerebral arteryPCAposterior cerebral arteryPTApercutaneous balloon angioplastySAHsubarachnoid hemorrhage