Is the Admiral (paclitaxel) balloon angioplasty device used to treat intracranial atherosclerosis?

From the Guidelines

The Admiral (paclitaxel) balloon angioplasty device is not used to treat intracranial atherosclerosis. The Admiral balloon is a drug-coated balloon (DCB) that is specifically designed and FDA-approved for use in peripheral arterial disease, particularly in the legs (femoropopliteal arteries) 1. For intracranial atherosclerosis, different devices and approaches are used due to the delicate nature of cerebral vasculature. Treatment of intracranial atherosclerosis typically involves either medical management with antiplatelet therapy and statins, or in select cases, specialized intracranial stents or balloon angioplasty devices specifically designed for the cerebral circulation. The use of paclitaxel-coated balloons in intracranial vessels would pose significant risks including potential neurotoxicity and increased risk of stroke. The blood-brain barrier and the unique characteristics of cerebral vessels require specialized devices with different safety profiles than those used in peripheral vascular interventions. According to the International Journal of Stroke, guidelines recommend medical management for patients with ischemic stroke or TIA caused by moderate to high-grade intracranial atherosclerotic stenosis (50–99%) 1. Additionally, the Canadian Stroke Best Practice Recommendations suggest that carotid-artery angioplasty with stenting (CAS) has emerged as an alternative to carotid endarterectomy in patients at high risk for complications for endarterectomy, but this is not applicable to intracranial atherosclerosis 1. In the context of intracranial atherosclerosis, the SAMMPRIS trial found that aggressive medical management was superior to intracranial stenting for patients with 70% to 99% stenosis of a major intracranial artery 1. Therefore, the use of the Admiral (paclitaxel) balloon angioplasty device is not recommended for the treatment of intracranial atherosclerosis. Some key points to consider in the management of intracranial atherosclerosis include:

• Medical management with antiplatelet therapy and statins
• Specialized intracranial stents or balloon angioplasty devices specifically designed for the cerebral circulation
• Avoidance of paclitaxel-coated balloons due to potential neurotoxicity and increased risk of stroke
• Aggressive medical management as the preferred treatment approach for patients with moderate to high-grade intracranial atherosclerotic stenosis.

From the Research

Admiral Paclitaxel Balloon Angioplasty Device

• The Admiral paclitaxel balloon angioplasty device has not been explicitly mentioned in the provided studies as a treatment for intracranial atherosclerosis.

Drug-Coated Balloon Angioplasty

• Drug-coated balloon (DCB) angioplasty has been used to treat intracranial atherosclerotic disease, as seen in studies 2, 3.
• DCB angioplasty has shown promising results, with low periprocedural risks and sustained treatment effects 2, 3.

Balloon Angioplasty for Intracranial Atherosclerotic Disease

• Balloon angioplasty has been used to treat intracranial atherosclerotic disease, with technical success achieved in 37 out of 39 cases in one study 4.
• The procedure has been shown to be safe and effective, with acceptable risks and promising outcomes 4.

Paclitaxel in Neurovasculature

• The safety of paclitaxel in the neurovasculature remains a concern, as mentioned in study 2.

Treatment of Intracranial Atherosclerotic Disease

• Various treatment options are available for intracranial atherosclerotic disease, including balloon angioplasty, stenting, and DCB angioplasty 5, 2, 3, 6, 4.
• The choice of treatment depends on the individual patient's condition and the severity of the disease.