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Submaximal Angioplasty for Severe Intracranial Atherosclerotic Stenosis: Benefit of Revascularization at Last

Umberto Pensato1,2, Andrew M Demchuk3, Geoffrey A Donnan4

  • 1Department of Neurology, IRCCS Humanitas Research Hospital, Milan, Italy (U.P.).

Stroke
|March 24, 2025
PubMed

Insights

Balloon angioplasty for symptomatic intracranial artery stenosis (BASIS) trial shows endovascular treatment benefits. Submaximal balloon angioplasty may offer a balance between safety and efficacy for stroke prevention.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Intracranial atherosclerotic stenosis is a major cause of stroke, with high recurrence risk.
  • Previous trials of angioplasty and stenting for intracranial stenosis yielded negative or neutral results.
  • Coronary artery disease interventions inspired exploration of similar approaches for intracranial disease.

Purpose of the Study:

  • To evaluate the efficacy and safety of endovascular treatment for symptomatic intracranial atherosclerotic stenosis.
  • To determine if submaximal balloon angioplasty improves outcomes compared to previous approaches.

Main Methods:

  • The BASIS trial was a randomized trial investigating balloon angioplasty for symptomatic intracranial artery stenosis.
  • Focused on submaximal balloon angioplasty to balance early complications and long-term efficacy.

Main Results:

  • The BASIS trial demonstrated the benefits of endovascular treatment in this patient population.
  • Submaximal balloon angioplasty emerged as a potentially optimal technique.

Conclusions:

  • Endovascular treatment, specifically submaximal balloon angioplasty, shows promise for secondary stroke prevention in intracranial atherosclerotic stenosis.
  • Further research is needed to address remaining uncertainties before widespread clinical adoption.

Keywords:
atherosclerosisintracranial arteriosclerosisischemic strokesecondary preventionstroke

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