Background Treatment of intracranial atherosclerotic disease (ICAD), a common cause of ischemic stroke worldwide, has been highly controversial. The SAMMPRIS trial revealed that best medical management (BMM) is superior to Gateway balloon angioplasty and Wingspan stenting for patients with symptomatic high-grade ICAD. Therefore, stenting is reserved for those failed BMM. Early evidence suggests that primary balloon angioplasty (PBA) may be an alternative option for ICAD who fails BMM. However, PBA of non-rapid-exchange system for ICAD has been frequently undermined due to the increase incidence of arterial recoil, restenosis and dissection.
Objective We report three cases of PBA using rapid-exchange coronary balloon for the treatment of symptomatic refractory ICAD in the vertebrobasilar arterial system who failed BMM. Cases: The cases consist of a 73-year-old-man with 90% vertebral artery stenosis, a 66-year-old-woman with 95% vertebrobasilar junction stenosis and a 49-year-old man with 98% stenosis of the basilar artery. Patients had history of hypertension, hyperlipidemia and smoking and failed BMM. Therefore, underwent rapid-exchange PBA using undersized Maverick coronary balloons. First case required single PBA using 2.5 × 20 mm balloon, 2nd required two PBA with 2 × 20 mm in two sessions and 3rd required single session three PBA using 2 × 20 mm. PBA resulting in reduction of stenosis less than 50% in all without any events and achievement of good clinical outcomes.
Conclusions Rapid-exchange PBA is technically feasible and may offers an alternative option to refractory ICAD who fails BMM. Further studies are warranted.
Disclosures Y. Lodi: None. S. Chin: None. B. Pulgarin: None. Z. Weiss: None. V. Reddy: 2; C; Terumo. 3; C; Janssen, Chiesi Inc, Portola.
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