Balloon Angioplasty for Intracranial Atherosclerotic Disease: a Multicenter Study

Abstract

Aim—To evaluate the role and efficacy of the balloon angioplasty in intracranial atherosclerotic disease
(ICAD) in patients who presented with acute stroke due to vessel occlusion and in patients with symptomatic disease despite optimum medical management.
Methods—From 2013 to 2016, a total of 39 patients (24 males and 15 females with a mean age of 64.5
years) underwent balloon angioplasty over a period of 2 years and 8 months in three different institutions in
India. Maverick balloon catheter (Boston scientific) is used in all the patients. MRI brain with MR angiogram was done in all the patients prior to intervention. Twenty-three patients who had underlying severe
ICAD presented with acute stroke due to vessel occlusion. Sixteen patients presented with symptomatic
ICAD with recurrent ischemic attack due to the progressing underlying disease despite optimum medical
management. Technical success, peri-procedural events, and clinical outcomes were documented for all the
patients.
Results—Technical success (residual stenosis < 50%) was achieved in 37 cases. Extra cranial carotid
stenting was required in 2 patients. In patients with acute stroke presentation (NIHSS score median of
16.5), adjuvant intravenous and intra-arterial tissue plasminogen activator were given in 8 and 3 patients,
respectively, and mechanical thrombectomy (MT) with solitaire was used in 15 patients. Patients who
underwent MT in acute stroke without ICAD were not included in the study. Reocclusion occurred in one
patient who developed disabling stroke and one patient died of intra-cerebral hemorrhage. Thus, the mortality of this study is 2%. Clinical outcome was assessed based on mRS. One-month, three-month, and sixmonth follow-up was available in >90% of the patients. MR angiogram on follow-up of nine months was
done in 26 patients, and none of them had restenosis.
Conclusion—Balloon angioplasty is a safe option and can be effectively used in patients of ICAD with
acceptable risks and promising outcomes.