Drug-Coated Balloon Versus Stent Angioplasty in Patients with Intracranial Atherosclerotic Disease: A Systematic

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Luiz Guilherme Silva Almeida1, Gabriel Semione2, Lucca Tamara Alves Carretta3

  • 1Department of Medicine, Catholic University of Brasília, Brasília, Brazil. lguilherme1109@gmail.com.

Neurosurgical Review
|June 4, 2025
PubMed

Insights

Drug-coated balloon (DCB) angioplasty shows promise for intracranial atherosclerotic disease (ICAD), demonstrating lower restenosis and ischemic events compared to stent angioplasty (SA). Further research is needed to confirm these findings in larger trials.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Intracranial atherosclerotic disease (ICAD) is a significant cause of ischemic stroke, particularly in high-risk populations.
  • Endovascular treatments like drug-coated balloon (DCB) angioplasty and stent angioplasty (SA) are options for severe ICAD.
  • Comparative data on DCB versus SA efficacy and safety is limited.

Purpose of the Study:

  • To compare the efficacy and safety of DCB angioplasty versus SA for treating ICAD.
  • To analyze rates of restenosis and recurrent ischemic events between the two endovascular approaches.

Main Methods:

  • A systematic literature search was performed across major databases (PubMed, Embase, Cochrane, Scopus, Web of Science) up to December 2024.
  • Included studies directly compared DCB angioplasty with SA in patients with ICAD.
  • Key outcomes assessed included symptomatic restenosis, overall restenosis, and recurrent ischemic events.

Main Results:

  • Three studies involving 213 patients were analyzed.
  • DCB angioplasty was associated with significantly lower overall restenosis rates (OR: 0.22) and recurrent ischemic events (OR: 0.20) compared to SA.
  • No significant difference was found in symptomatic restenosis rates between DCB and SA (OR: 0.34).

Conclusions:

  • DCB angioplasty appears to be a potentially safer and more effective treatment for ICAD than SA, with reduced restenosis and ischemic complications.
  • Current evidence relies heavily on observational studies.
  • Multicenter randomized controlled trials are essential to definitively establish the comparative effectiveness and long-term outcomes of DCB versus SA in ICAD management.
Abstract

Keywords:
Cerebrovascular diseaseDrug-Coated balloonEndovascular treatmentIntracranial atherosclerotic stenosisStent angioplasty

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