title: Prevention of intracranial in-stent restenoses: predilatation with a drug eluting balloon, followed by the deployment of a self-expanding stent.
abstract: OBJECTIVE
  Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions.
  
  
  METHODS
  Fifty-two patients (median age: 71 years; range: 54-86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. 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 an ISR were analyzed.
  
  
  RESULTS
  Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion.
  
  
  CONCLUSIONS
  Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.
authors.affiliation: Klinik für Neuroradiologie, Neurozentrum, Klinikum Stuttgart, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany. Z.Vajda@klinikum-stuttgart.de
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Vajda
authors.forename: Thomas
authors.initials: T
authors.lastname: Güthe
authors.forename: Marta Aguilar
authors.initials: MA
authors.lastname: Perez
authors.forename: Wiebke
authors.initials: W
authors.lastname: Kurre
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schmid
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Bäzner
authors.forename: Hans
authors.initials: H
authors.lastname: Henkes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods*; D002533:Cerebral Angiography; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel