Front Neurol. 2026 Sep 16;17:1828034. doi: 10.3389/fneur.2026.1828034. eCollection 2026.
ABSTRACT
BACKGROUND: Direct balloon dilatation angioplasty (DBDA) is an established treatment for intracranial atherosclerotic stenosis (IAS) without acute ischemia; however, its role in IAS-induced acute ischemic stroke (ICAS-LVO) remains poorly defined. This retrospective single-arm study aimed to evaluate the technical feasibility, safety, and 90-day functional outcomes of DBDA in a selected cohort of patients with ICAS-LVO.
METHODS: Data from 28 consecutive patients with ICAS-LVO who underwent DBDA as the primary recanalization strategy at Huzhou Central Hospital (October 2018-December 2020) were retrospectively analyzed. Safety endpoints included intraprocedural dissection, plaque retraction, distal embolism, the need for remedial stenting, symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Technical success was defined as postprocedural modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days.
RESULTS: Among the 28 patients (mean admission NIHSS 16.5 ± 5.6), 23 (82.1%) received intravenous thrombolysis prior to intervention. Intraprocedural dissection occurred in one patient, and plaque retraction with flow failure occurred in another patient, with both patients requiring remedial stenting. sICH was observed in one patient (3.6%); no distal embolization or 90-day mortality was observed. Successful reperfusion (mTICI 2b-3) was achieved in 26 patients (92.9%; 95% CI 77.4-98.0%), with mTICI 2b achieved in 9 (32.1%; 95% CI 17.2-51.6%) and mTICI 3 in 17 (60.7%; 95% CI 42.2-76.8%) patients. The median puncture-to-revascularization time was 65 min (IQR 55-78). The median NIHSS at discharge was 4 (IQR 2-8). At 90 days, 18 patients (64.3%; 95% CI 45.8-79.8%) achieved functional independence (mRS 0-2).
CONCLUSION: In this highly selected cohort of ICAS-LVO patients, DBDA was associated with a high rate of successful reperfusion and favorable 90-day functional outcomes. However, given the single-arm retrospective design, the absence of a control group, and the high rate of intravenous thrombolysis use, these findings are hypothesis-generating only. The observed outcomes cannot be attributed to DBDA alone and require validation in multicenter randomized trials.
PMID:42819166 | PMC:PMC13623690 | DOI:10.3389/fneur.2026.1828034