Paclitaxel Drug-Coated Balloon Angioplasty for Medically Refractory Intracranial Atherosclerotic Disease: A US Single-Center Experience With the AGENT Balloon

BACKGROUND: Intracranial atherosclerotic disease is associated with up to 10% of ischemic strokes and a high risk of recurrence. Endovascular treatments including percutaneous transluminal angioplasty and stenting have failed to demonstrate improved outcomes compared with medical therapy alone. Drug-coated balloon (DCB) angioplasty has emerged as a promising alternative, though its safety and durability remain uncertain. METHODS: This single-center retrospective study analyzed consecutive patients with refractory intracranial atherosclerotic disease treated with AGENT drug-coated balloon submaximal angioplasty. Stenosis was quantified according to the WASID criteria (Warfarin-Aspirin Symptomatic Intracranial Disease). Patients were treated either for refractory large-vessel occlusion during thrombectomy (emergency rescue) or for recurrent ischemic symptoms from high-grade stenosis (elective primary). Primary outcome was technical success, defined as