Submaximal versus aggressive angioplasty with drug-coated balloons for symptomatic intracranial arterial stenosis.

Background: Drug-coated balloons (DCB) can decrease the incidence of restenosis in the treatment of intracranial atherosclerotic stenosis (ICAS). This study aimed to assess the safety and efficacy of submaximal angioplasty with DCB dilation compared with aggressive angioplasty in patients with symptomatic ICAS.
Methods: This study prospectively and consecutively enrolled patients with symptomatic ICAS who underwent DCB angioplasty between January 2021 and December 2023. Based on the balloon size, the patients were divided into submaximal (50-80% of normal vessel diameter) or aggressive (80-100% of normal vessel diameter) angioplasty groups. The efficacy and safety of angioplasty including ischemic stroke/intracranial hemorrhage, death, arterial dissection, and follow-up outcomes were compared between the two groups.
Results: The patients were divided into submaximal (n=55) and aggressive (n=62) angioplasty groups. All the balloons were successfully delivered to the lesion location and expanded. The dissection rate (3.6% vs 17.7%, P=0.018) and incidence of remedial stenting (7.3% vs 21.0%, P=0.040) after balloon dilation were significantly greater after aggressive angioplasty than after submaximal angioplasty. A residual stenosis rate of ≥30% was more common in the submaximal angioplasty group than in the aggressive angioplasty group (27.3% vs 8.1%, P=0.006). Periprocedural complications (1.8% vs 8.1%, P=0.212), recurrent ischemic events (1.8% vs 4.8%, P=0.621), and restenosis (3.6% vs 8.1%, p=0.445) were comparable between the groups.
Conclusions: Submaximal angioplasty has a favorable technical profile, periprocedural safety, and long-term efficacy, suggesting that it is a promising alternative treatment for symptomatic ICAS.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)