Drug-Eluting Stents and Drug-Coated Balloons for Intracranial Atherosclerotic Disease: Reduced Restenosis, But Is It Enough?

Abstract

Symptomatic intracranial atherosclerotic disease (ICAD) carries a recurrent stroke risk that can approach 38% despite best medical therapy, and endovascular revascularization has long seemed an attractive adjunct to pharmacotherapy. Drug-eluting stents (DES) combine a permanent scaffold with an antiproliferative coating (sirolimus or paclitaxel), while drug-coated balloons (DCB) deliver the same class of agent to the vessel wall without leaving a permanent implant, a potentially attractive feature in a circulation of small, tortuous vessels with vulnerable perforating branches. Taken together, the available data support a genuine and biologically plausible reduction in angiographic restenosis with DES and DCB relative to bare-metal or uncoated approaches, but do not yet establish that either technology reduces clinical stroke recurrence, nor do they resolve the periprocedural safety concerns intrinsic to intracranial endovascular intervention.