Early versus Delayed Drug-Coated Balloons for Symptomatic Intracranial Atherosclerotic Stenosis

In recent years, drug-coated balloons (DCB) have been increasingly used for intervention therapy of intracranial atherosclerotic stenosis (ICAS) with significant efficacy. However, the timing of DCB intervention therapy remains controversial, and there are few published studies that further investigated this. This study aimed to evaluate the clinical outcomes of early (≤21 days) versus delayed (21-42 days) DCB treatment in patients with ICAS. Symptomatic ICAS (sICAS) patients who underwent DCB angioplasty between August 2021 and March 2024 were included in the study. Based on the time from the last qualifying event (QE) to the procedure, patients were divided into an early group (≤21 days) and a delayed group (21-42 days). The efficacy and safety of DCB angioplasty, including perioperative complications and restenosis, were recorded and compared between the two groups. A total of 186 patients were enrolled, with 75 in the early group and 111 in the delayed group where all patients underwent DCB angioplasty successfully. The delayed group showed significantly lower postoperative residual stenosis (10 ​% vs. 20 ​%, P ​= ​0.041) and restenosis rates (10.81 ​% vs. 22.67 ​%, P ​= ​0.029) at the 12-month follow-up compared to the early group. The delayed group also had numerically lower perioperative complication rates (5.41 ​% vs. 9.33 ​%, P ​= ​0.303) and recurrence rates (7.21 ​% vs. 9.33 ​%, P ​= ​0.601), however these differences were not statistically significant. Our study concludes that in patients with sICAS, performing DCB angioplasty within 21 days may carry a higher degree of residual stenosis and an increased long-term risk of restenosis.