Transcranial duplex ultrasound monitoring of intracranial arterial stenosis treated with ELUTAX "3" drug-eluting balloon.

We report the results of transcranial ultrasound monitoring in three patients with intracranial arterial stenosis of the middle cerebral artery treated with the only drug-eluting balloon certificated for intracranial use in highly symptomatic intracranial arterial stenosis, ELUTAX "3" (AR Baltic Medical). We performed transcranial Doppler ultrasounds 24 h, 72 h, 10 days, 15 days and 30 days after the angioplasty, thereby measuring mean flow velocity (MFV) in the maximum stenosis area in patients with symptomatic steno-occlusive disease of the middle cerebral artery treated with ELUTAX "3". Two patients were treated during mechanical thrombectomy (MT) due to acute ischemic stroke and one patient was treated on elective basis due to symptomatic pre-occlusive stenosis, with recurrent transient ischemic attacks (TIAs) refractory to medical therapy. In Case 1, the first transcranial Doppler ultrasounds evidenced MFV of 348 cm/s, with progressive MFV reduction until 15 days post-treatment, with MFV of 177 cm/s. In Case 2, 24 h after angioplasty had an MFV of 258 cm/s, decreasing to 103 cm/s at 30 days. Case 3 had an MFV of 436 cm/s before angioplasty that immediately decreased after the procedure to 364 cm/s, with a final MFV of 260 cm/s at 30 days. We have recorded a progressive MFV reduction in intracranial arterial stenosis, with better outcomes in patients treated during MT. In our experience, the use of ELUTAX "3" for the treatment of symptomatic intracranial arterial stenosis achieves a progressive improvement of stenosis, evident in the first weeks, to a higher extent in cases of occlusive thrombosis. More studies are needed to provide more information about this device.

Device profile of different paclitaxel-coated balloons: Neuro Elutax SV, Elutax '3' Neuro and SeQuent Please NEO for the treatment of symptomatic intracranial high-grade stenosis: overview of their feasibility and safety.

Introduction: Intracranial atherosclerotic disease (ICAD) is highly prevalent and probably the most common cause of stroke worldwide. Despite best medical treatment (BMT), the rate of recurrent stroke in symptomatic ICAD patients is elevated, especially in those with high-grade stenosis. Thus, alternative treatment options are needed. So far, endovascular ICAD treatment has been considered a second-line therapy. However, recent progress in the endovascular acute stroke treatment challenges this issue. Drug-coated balloon (DCB) - percutaneous transluminal angioplasty (PTA) represents a promising alternative to BMT alone.Areas covered: In this review, current clinical studies on paclitaxel-coated DCB-PTA in symptomatic high-grade ICAD patients will be presented and discussed. Furthermore, technical profile of the different paclitaxel-coated DCB, which has been used for intracranial use (Neuro Elutax SV, Elutax '3' Neuro, and SeQuent Please NEO) are being presented.Expert opinion: Despite limited data and its experimental (off-line) use, DCB-PTA has been demonstrated to be feasible and safe in selected ICAD patients with symptomatic high-grade stenosis. DCB-PTA offers several advantages compared to alternative endovascular therapy option as well as BMT alone. Consequently, DCP-PTA might be a promising candidate for the future armamentarium in ICAD treatment.