Drug-Coated Balloons Outperform Bare-Metal Stents in Reducing Restenosis for Symptomatic Intracranial Stenosis

Introduction: The Challenge of Intracranial Restenosis

Symptomatic intracranial atherosclerotic disease (ICAD) remains a leading cause of stroke worldwide, particularly in Asian populations. While medical management is the first line of defense, patients with high-grade stenosis (70-99%) often require endovascular intervention due to a high risk of recurrent ischemic events. Historically, the use of bare-metal stents (BMS) provided a mechanical solution to vessel narrowing, but this approach has been perpetually hampered by high rates of in-stent restenosis (ISR). The inflammatory response triggered by the metallic scaffold often leads to neointimal hyperplasia, effectively re-occluding the vessel over time.

Drug-coated balloons (DCB), which deliver antiproliferative agents like paclitaxel directly to the vessel wall without leaving a permanent foreign body, have emerged as a promising alternative. The DR. BEYOND trial, a multicenter randomized controlled trial recently published in Radiology, provides robust evidence on whether this technology can finally overcome the limitations of traditional stenting in the intracranial circulation.