Voice of China: Balloon angioplasty combined with drug therapy vs drug therapy alone, who is better?

Intracranial atherosclerotic disease (ICAD) is the most common cause of ischemic cerebrovascular events
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Patients with ICAD are at very high risk of stroke recurrence and death
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Previous non-randomized studies have shown that stroke and mortality in ICAD patients with severe intracranial artery stenosis are lower than those with active medication
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To determine whether intracranial balloon angioplasty combined with aggressive medical therapy is superior to medical therapy alone in preventing the primary endpoint in patients with ischemic stroke due to neurovascular stenosis (≥70%), the authors of this study were Sun Xuan and Professor Miao Zhongrong from the Neurointerventional Center of Beijing Tiantan Hospital Affiliated to Capital Medical University
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The findings were presented as a poster abstract at the International Stroke Congress 2022 (ISC 2022)
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The author of this article: Yimaitong ISC report group compiled and organized by Yimaitong, please do not reprint without authorization
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STUDY INTRODUCTION The Balloon Angioplasty for Symptomatic Intracranial Arterial Stenosis (BASIS) Trial is a multicenter, prospective, randomized, parallel-controlled study
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The primary objective of this study was to determine whether intracranial balloon angioplasty combined with aggressive medical therapy is superior to aggressive medical therapy alone for the prevention of ischemic stroke (≥70%) in patients with neurovascular stenosis.
Primary endpoints include: (1) Stroke (including hemorrhagic and ischemic stroke) and all-cause mortality within 30 days after enrollment
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(2) Ischemic stroke caused by involved blood vessels within 31 days to 12 months after enrollment
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Active medical treatment was the same in both groups, including 100 mg of aspirin per day throughout follow-up and 75 mg of clopidogrel per day for the first 90 days after enrollment
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Patients in both groups also required management of primary risk factors (blood pressure 130-140/90-100 mmHg, LDL <70 mg/dl) and secondary risk factors
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 MAIN FINDINGS: The investigators hypothesized that angioplasty with appropriate balloon selection was sufficiently safe and effective to not increase ischemic/hemorrhagic stroke rates within 30 days
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Angioplasty combined with optimal medical therapy is expected to reduce the risk of recurrent ischemic stroke due to arterial causes by a relative 50%, with an estimated incidence of 15% in the control group and 7% in the treatment group at 1-year follow-up
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 CONCLUSIONS BASIS is the first randomized trial to compare angioplasty combined with optimal medical treatment versus optimal medical treatment alone
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The use of appropriate balloons during surgery and short-term dual antiplatelet therapy after surgery can minimize the risk of major bleeding
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Based on the results of the BASIS study, angioplasty can be used as an independent or alternative treatment in patients with severe intracranial atherosclerotic stenosis
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 Compiled from: Balloon Angioplasty For Symptomatic Intracranial Artery Stenosis.
ISC 2022.