Assessment of paclitaxel drug-coated balloon angioplasty for intracranial atherosclerotic disease based on high-resolution vessel wall magnetic resonance imaging
Restricted accessResearch articleFirst published online 2024
Assessment of paclitaxel drug-coated balloon angioplasty for intracranial atherosclerotic disease based on high-resolution vessel wall magnetic resonance imaging
To accurately assess the treatment effect of paclitaxel drug-coated balloon (DCB) angioplasty is essential for intracranial atherosclerotic disease (ICAD) patients. This study aimed to investigate the clinical feasibility of high-resolution vessel wall MRI (HR-VWI) in assessing ICAD with DCB angioplasty.
Methods
Forty-five patients with intracranial atherosclerotic stenosis ≥ 70% confirmed by digital subtraction angiography (DSA) underwent HR-VWI before and after DCB angioplasty. Postoperative follow-up was performed after 6 months (±1 month). The differences of pre- and postoperative HR-VWI characteristics, including vessel and lumen area at maximal lumen narrowing (MLN), plaque area and length, degree of stenosis, plaque burden (PB), remodeling index, and plaque enhancement amplitude (PEA) were compared. The relationship between stenotic rate obtained using HR-VWI and DSA was evaluated. Each HR-VWI characteristic and clinical factor before DCB angioplasty was separately evaluated for the association with postoperative restenosis.
Results
After six months, lumen area of MLN, plaque length and area, degree of stenosis, PB, and PEA showed a significantly difference relative to the value before DCB angioplasty (all P < 0.05). Spearman correlation coefficients of 0.865 and 0.932 were revealed between DSA and HR-VWI regarding the stenotic rate analysis pre- and post-operation (both P < 0.05). ROC analysis showed PEA, plaque length, and PB before DCB angioplasty separately provided robust prediction of postoperative restenosis (area under the curve = 0.909, 0.814 and 0.743; all P < 0.05). Multivariable analysis revealed that PEA was an independent predictor of prognosis.
Conclusions
The HR-VWI can accurately assess the treatment effect of DCB and robustly predict prognosis.
WangYZhaoXLiuL, et al.Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) study. Stroke2014; 45: 663–669.
2.
YangHJiCWangH, et al.Characterisation of symptomatic intracranial plaque without substantial stenosis using high-resolution vessel wall MRI. Clin Radiol2021; 76: 392.e21–392.e26.
MekonnenEATekleWGDesaiSK, et al.Angioplasty And stenting For symptomatic intracranial atherosclerotic disease: How I Do It. Interv Neuroradiol 2023; 29: 459–465.
6.
BarnardZRAlexanderMJ. Update in the treatment of intracranial atherosclerotic disease. Stroke Vasc Neurol2020; 5: 59–64.
BanerjeeCChimowitzMI. Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res2017; 120: 502–513.
9.
NguyenLMaingardJJhambA, et al.Intracranial atherosclerotic disease and acute ischaemic stroke: a review of diagnosis and management. J Med Imaging Radiat Oncol2022; 66: 391–403.
10.
NaftaliJFindlerMPerlowA, et al.Intracranial stenting for large vessel intracranial atherosclerotic disease: Retrospective study. Interv Neuroradiol2023; 27: 15910199231190685. Online ahead of print.
11.
LiAYeZZhouW,et al.Short-term outcome of stenting with enterprise stents for symptomatic intracranial atherosclerotic disease at a single center. Interv Neuroradiol2023; 29: 731–737.
12.
BettencourtSEssibayiMABaptistaM, et al.Acute intracranial stenting in acute ischemic stroke with underlying atherosclerosis: a two-center retrospective study. Interv Neuroradiol 2023; 12: 15910199231219849.
13.
JiangWJCheng-ChingEAbou-CheblA, et al.Multicenter analysis of stenting in symptomatic intracranial atherosclerosis. Neurosurgery2012; 70: 25–31.
14.
LiTXGaoBLCaiDY, et al.Wingspan stenting for severe symptomatic intracranial atherosclerotic stenosis in 433 patients treated at a single medical center. PLoS One2015; 10: e0139377.
15.
GruberPBraunCKahlesT, et al.Percutaneous transluminal angioplasty using the novel drug-coated balloon catheter SeQuent please NEO for the treatment of symptomatic intracranial severe stenosis: feasibility and safety study. J Neurointerv Surg2019; 11: 719–722.
16.
WangAY-CChangC-HChenC-C, et al.Leave nothing behind: treatment of intracranial atherosclerotic disease with drug-coated balloon angioplasty. Clin Neuroradiol2021; 31: 35–44.
17.
GruberPSinghSAndereggenL, et al.Drug-coated balloons for the treatment of symptomatic intracranial high-grade stenosis: a review of the current rationale. Front Neurol2021; 12: 692208.
18.
YinHZhangJZhaoW, et al.Drug-coated balloon for the treatment of nonacute symptomatic intracranial carotid artery terminus occlusion: initial experience and follow-up outcome. Front Neurol2022; 13: 840865.
19.
ZhaoWChuXSongY, et al.Drug-coated balloon treatment for delayed recanalization of symptomatic intracranial artery occlusion. Transl Stroke Res2023; 14: 193–199.
20.
SchornIMalinoffHAndersonS, et al.The Lutonix® drug-coated balloon: a novel drug delivery technology for the treatment of vascular disease. Adv Drug Deliv Rev2017; 112: 78–87.
21.
VajdaZGütheTPerezMA, et al.Neurovascular in-stent stenoses: treatment with conventional and drug-eluting balloons. AJNR Am J Neuroradiol2011; 32: 1942–1947.
22.
LinXGuoWSheD, et al.Follow-up assessment of atherosclerotic plaques in acute ischemic stroke patients using high-resolution vessel wall MR imaging. Neuroradiology2022; 64: 2257–2266.
23.
VranicJEHartmanJBMossa-BashaM. High-resolution magnetic resonance vessel wall imaging for the evaluation of intracranial vascular pathology. Neuroimaging Clin N Am2021; 31: 223–233.
24.
GongYCaoCGuoY, et al.Quantification of intracranial arterial stenotic degree evaluated by high-resolution vessel wall imaging and time-of-flight MR angiography: reproducibility, and diagnostic agreement with DSA. Eur Radiol2021; 31: 5479–5489.
FakihRVaron MillerARaghuramA, et al.High resolution 7T MR imaging in characterizing culprit intracranial atherosclerotic plaques. Interv Neuroradiol 2022; 26: 15910199221145760. Online ahead of print.
27.
LinGHSongJXFuNX, et al.Quantitative and qualitative analysis of atherosclerotic stenosis in the middle cerebral artery using high-resolution magnetic resonance imaging. Can Assoc Radiol J2021; 72: 783–788.
28.
RanYWangYZhuM, et al. Higher plaque burden of middle cerebral artery is associated with recurrent ischemic stroke: a quantitative magnetic resonance imaging study. Stroke2020; 51: 659–662.
29.
CorbanMTEshtehardiPSuoJ, et al.Combination of plaque burden, wall shear stress, and plaque phenotype has incremental value for prediction of coronary atherosclerotic plaque progression and vulnerability. Atherosclerosis2014; 232: 271–276.
30.
YangDLiuJYaoW, et al.The MRI enhancement ratio and plaque steepness may be more accurate for predicting recurrent ischemic cerebrovascular events in patients with intracranial atherosclerosis. Eur Radiol2022; 32: 7004–7013.
31.
HuangJJiaoSZhaoX, et al.Characteristics of patients with enhancing intracranial atherosclerosis and association between plaque enhancement and recent cerebrovascular ischemic events: a high-resolution magnetic resonance imaging study. Acta Radiol2019; 60: 1301–1307.
32.
ZhangDFChenYCChenH, et al.A high-resolution MRI study of relationship between remodeling patterns and ischemic stroke in patients with atherosclerotic middle cerebral artery stenosis. Front Aging Neurosci2017; 9: 140.
33.
LiuQHuangJDegnanAJ, et al.Comparison of high-resolution MRI with CT angiography and digital subtraction angiography for the evaluation of middle cerebral artery atherosclerotic steno-occlusive disease. Int J Cardiovasc Imaging2013; 29: 1491–1498.
34.
KimJMJungKHSohnCH, et al.Intracranial plaque enhancement from high resolution vessel wall magnetic resonance imaging predicts stroke recurrence. Int J Stroke2016; 11: 171–179.
35.
LeeJ-HKimUKimJ-S, et al.Clinical implication of neointimal burden in in-stent restenosis treated with drug-coated balloon. Catheter Cardiovasc Interv2021; 98: 493–502.
36.
FanelliFCannavaleAGazzettiM, et al.Calcium burden assessment and impact on drug-eluting balloons in peripheral arterial disease. Cardiovasc Intervent Radiol2014; 37: 898–907.
37.
MicariABrodmannMKeirseK, et al.Drug-coated balloon treatment of femoropopliteal lesions for patients with intermittent claudication and ischemic rest pain: 2-year results from the IN.PACT global study. JACC Cardiovasc Interv2018; 11: 945–953.
38.
ZhaoLZhaoHXuY, et al.Plaque length predicts the incidence of microembolic signals in acute anterior circulation stroke. Dis Markers2021; 2021: 1–7.
39.
YoshiokaNTokudaTKoyamaA, et al.on the ASIGARU PAD investigators. Clinical outcomes and predictors of restenosis in patients with femoropopliteal artery disease treated using polymer-coated paclitaxel-eluting stents or drug-coated balloons. Heart Vessels2022; 37: 555–566.
