Impact of drug-coated balloon for vascular luminal dilatational remodeling after balloon angioplasty in intracranial atherosclerotic stenosis – a retrospective cohort study

OBJECTIVE: This study aimed to examine the effect of drug-coated balloons (DCBs) on vascular luminal dilatational remodeling (VLDR) following simple balloon angioplasty. METHODS: A retrospective cohort study was conducted using data from patients diagnosed with intracranial atherosclerotic stenosis (ICAS), who were treated exclusively with balloon angioplasty at Henan Provincial People's Hospital between June 2019 and April 2023. Inverse probability weighting (IPW) was used to create balanced cohorts of patients who underwent drug-coated balloon angioplasty (DCBA) and plain old balloon angioplasty (POBA). The primary endpoint was VLDR occurrence during follow-up, with the effect of DCBA on VLDR assessed by adjusted multivariate regression. RESULTS: The study included 110 patients who underwent simple percutaneous transluminal angioplasty, with 60 in the DCBA group and 50 in the POBA group. At follow-up, the stenosis rate in the DCBA group was lower than in the POBA group (P<0.001). The decrease in stenosis rate (DSR) was greater in the DCBA group compared with the POBA group (P<0.001). Nineteen patients (31.7%) in the DCBA group experienced VLDR, whereas only four (8%) in the POBA group developed VLDR, a statistically significant difference (P=0.002). After IPW adjustment, differences in stenosis rate (34.17 (20.00, 46.72) vs 46.00 (37.88, 70.00), P<0.001), DSR (-1.66 (-16.71, 11.40) vs -18.00 (-28.00, -3.00), P<0.001) and VLDR incidence (32.2% vs 9.9%, P<0.001) between the DCBA and POBA groups remained significant. Multivariate regression analysis identified DCBA as an independent factor influencing VLDR occurrence. CONCLUSION: This study demonstrated that, compared with POBA, DCBA increases VLDR occurrence in ICAS patients during follow-up.