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

ABSTRACT

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.

KEYWORDS:

• Drug-coated balloon
• Elutax ‘3’ Neuro
• intracranial atherosclerotic disease
• Neuro Elutax SV
• paclitaxel
• percutaneous transluminal angioplasty
• ischemic stroke
• SeQuent Please NEO

Article highlights

• Intracranial atherosclerotic disease (ICAD) is highly prevalent and probably the most common cause of stroke worldwide.

• Current guidelines recommend the best medical treatment (BMT) as first-line therapy. Despite BMT, the stroke recurrence rate is elevated in symptomatic ICAD patients with high-grade stenosis.

• Drug-coated balloon percutaneous trans-luminal angioplasty (DCB-PTA) might offer an efficient alternative treatment option.

• Despite its current experimental use, DCB-PTA is feasible and safe in well-selected ICAD patients.

• Neuro Elutax SV and SeQuent Please NEO have been proven to be feasible and safe in ICAD patients with symptomatic high-grade stenosis.

• Large randomized trials are needed to prove the concept that DCB-PTA is effective in ICAD patients.

• To our opinion, DCB-PTA has the potential to play an important role in the endovascular treatment of ICAD.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.