1Shorog Althubait, 1Hamada A. Salam, 1Hani Lababidi, 1Sultan Alqahtani

1Saudi German Hospital, Riyad

Background(s):

Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide, associated with a high risk of recurrent stroke in spite of the presence of many therapeutic options, knowing that the current ASA guidelines (2021) recommend that medical therapy (anti-thrombotic, risk factors control, lifestyle modifications) is the first and main option for treatment of symptomatic ICAS (stroke or TIA patient) even if recurrent, while interventional therapy (angioplasty with or without stenting) still questionable.

To evaluate the outcome, safety, and effectiveness of intracranial balloon angioplasty without stenting as first option for symptomatic intracranial stenosis compared to aggressive medical therapy and intracranial stenting

Material(s) and Method(s):

Forty-five patients with symptomatic ICAS were enrolled and equally randomized in this study, where fifteen patients(medical group) underwent medical treatment(antiplatelets therapy+control risk factors+life style modification), fifteen patients (angioplasty group) underwent angioplasty without stenting using (drug-eluting ballon) and fifteen patients(stenting group) underwent angioplasty with stenting.

Result(s):

The angioplasty group had a better clinical and radiological outcome with NIHSS below or equal (6) at 12 months follow up post-procedure in (100%) of the patients in the angioplasty group, in comparison to (80%) of the patients in both medical group and stenting group. also, a better functional outcome with MRS score (0:1) at 12 months follow-up post-procedure in (93,3%) of the patients in the angioplasty group, in comparison to (66,7%) in the medical group and (80%) in stenting group. Brain imaging (CT or MRI) show ( no significant new insult )at 12 months follow up post-procedure in the angioplasty group in (100 %) of the patients, while( 80%) of the patients in both medical and stenting groups show (no significant new insult), in addition to, cerebrovascular imaging(CTA or MRA) show (no significant restenosis) at 12 months follow up post procedure in angioplasty group in (100%) of the patients in comparison to (80%) in the medical group and (80%) in stenting group, recurrent ischemic events occurred in (0%) of angioplasty group, with (20%) of medical group and (13,3%) of stenting group.

Conclusion(s):

At the end of this study, we can conclude that intracranial balloon angioplasty using drug-eluting ballon is superior for both medical therapy and intracranial stenting

and safe as the first option for treatment of symptomatic intracranial stenosis further randomized control trials are required since it will change the current practice paradigm.