From the Guidelines
The Admiral balloon angioplasty device should not be used as a first-line therapy for treating intracranial stenosis, as aggressive medical management of risk factors and short-term dual antiplatelet therapy are preferred. According to the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack by the American Heart Association/American Stroke Association 1, patients with severe intracranial stenosis in the vascular territory of ischemic stroke or transient ischemic attack should not receive angioplasty and stenting as a first-line therapy for preventing recurrence.
Some key points to consider when evaluating the use of the Admiral balloon angioplasty device for intracranial stenosis include:
- The device is designed for the treatment of atherosclerotic stenosis in intracranial arteries
- The procedure is typically used in patients who have symptomatic intracranial atherosclerotic disease (ICAD) and have failed medical management with antiplatelet therapy and risk factor modification
- The procedure is performed by neurointerventionalists in a specialized angiography suite
- Patients undergoing this procedure will require dual antiplatelet therapy before and after the intervention to prevent thromboembolic complications
However, the most recent and highest quality study, the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack by the American Heart Association/American Stroke Association 1, recommends against the use of angioplasty and stenting as a first-line therapy for preventing recurrence in patients with severe intracranial stenosis.
It's also worth noting that other studies, such as the indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research 1, provide information on the use of endovascular therapy for intracranial stenosis, but the 2021 guideline 1 is the most recent and highest quality study.
Additionally, other guidelines, such as the guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association 1, provide recommendations for the prevention of stroke in patients with stroke or transient ischemic attack, but the 2021 guideline 1 is the most relevant to the question of whether the Admiral balloon angioplasty device should be used to treat intracranial stenosis.
From the Research
Admiral Balloon Angioplasty Device for Intracranial Stenosis
- The provided studies do not specifically mention the use of the Admiral balloon angioplasty device for treating intracranial stenosis.
- However, several studies discuss the use of balloon angioplasty and stenting for intracranial atherosclerotic disease, including the Wingspan stent system 2 and drug-coated balloon angioplasty 3.
- These studies suggest that balloon angioplasty and stenting can be effective and safe for treating intracranial stenosis, with high technical success rates and acceptable periprocedural morbidity 2, 3.
- The use of paclitaxel-coated balloons for intracranial symptomatic in-stent restenosis has also been shown to be feasible and safe 4.
- Another study compared balloon-mounted stents and self-expandable stents for intracranial stenosis, finding that balloon-mounted stents were more effective in reducing the degree of stenosis and had lower rates of complications 5.
- An early study on balloon angioplasty of intracranial arteries for stroke prevention reported successful dilation in all treated vessels, with no recurrence of transient ischemic attacks and no restenosis at the angioplasty site over a follow-up period of more than 24 months 6.