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Published on: May 14, 2013
Neurovascular in-stent stenoses: treatment with conventional and drug-eluting balloons
Z Vajda1, T Güthe, M Aguilar Perez
1Klinik für Neuroradiologie, Bürgerhospital, Klinikum Stuttgart, Germany.
Insights
Drug-eluting balloons (DEBs) show promise in treating in-stent restenosis (ISR) after intracranial angioplasty, significantly reducing restenosis rates compared to conventional balloons.
Area of Science:
- Neuroendovascular interventions
- Cardiovascular research
- Medical device technology
Background:
- In-stent restenosis (ISR) is a significant challenge in endovascular treatment of intracranial atherosclerotic disease (ICAD).
- Retreatment via reangioplasty is often necessary for ISR management.
- Novel drug-eluting balloons (DEBs) offer a potential solution for neurovascular ISR.
Purpose of the Study:
- To assess the technical feasibility of using DEBs for neurovascular ISR.
- To evaluate the safety and efficiency of DEBs in treating intracranial ISR.
- To compare DEB outcomes with conventional balloon angioplasty for ISR.
Main Methods:
- A single-center study included 51 patients undergoing 63 balloon dilation procedures for intracranial ISR.
- Procedures utilized either conventional balloons (32%) or paclitaxel-eluting balloons (DEBs) (68%).
- Follow-up included serial angiographic and clinical assessments to analyze technical success, complications, and recurrence rates.
Main Results:
- 100% technical success was achieved in all cases, with DEB failure in 6% successfully treated by conventional balloons.
- The 30-day combined permanent neurologic morbidity and mortality rate was 1.6%.
- DEBs demonstrated a significantly lower rate of recurrent stenosis (9%) compared to conventional balloons (50%).
Conclusions:
- Initial results suggest DEBs are effective for intracranial ISR reangioplasty.
- DEBs show a marked reduction in recurrent stenosis rates.
- Further technical advancements are needed for optimal DEB application in neurovascular ISR.
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.
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