Drug-eluting stent opening blocked artery in brain

Drug-Eluting Stents: A Promising Solution for Intracranial Atherosclerosis?

Soraya Malik in Health & Wellness August 2025 • 4 min read.

"Find out how these innovative stents offer a safer, more effective approach to treating blocked arteries in the brain and preventing stroke."

Intracranial atherosclerotic disease (ICAD), a major cause of stroke worldwide, especially among Asians, Blacks, and Hispanics, involves the narrowing of arteries within the brain. Traditional treatments for symptomatic ICAD (sICAD) have been evolving, but new solutions are needed. The WASID and SAMMPRIS trials highlighted the challenges and limitations of medical management and traditional stenting procedures.

While aggressive medical management and risk factor control are essential, some patients require more. Percutaneous transluminal angioplasty and stenting (PTAS) techniques have been explored; self-expanding stents (SES) and bare metal stents (BMS) were common. However, the SAMMPRIS and VISSIT trials were stopped early because the stent groups showed increased perioperative complications and no long-term benefit.

The problem? In-stent restenosis (ISR), the re-narrowing of the artery after stenting. Drug-eluting stents (DES), widely used in coronary artery disease, slowly release medication to inhibit cell growth and reduce ISR. Now, researchers are exploring DES for ICAD to improve outcomes. This article examines a systematic review and meta-analysis of DES for ICAD, assessing their efficacy and safety compared to other treatments.

Do Drug-Eluting Stents Reduce Complications and Improve Outcomes?

Drug-eluting stent opening blocked artery in brain

To evaluate the effectiveness of DES for ICAD, researchers conducted a thorough review of medical literature. They analyzed 13 studies involving 336 patients (364 lesions) treated with DES, focusing on key outcomes:

Here's what the analysis revealed about DES:

Perioperative Complications: Occurred in 6.0% of patients.
Long-Term Complications: Occurred in 2.2% of patients.
In-Stent Restenosis (ISR): 4.1% of patients experienced ISR.
Symptomatic ISR: Only 0.5% of patients had symptomatic ISR.

Importantly, a subgroup analysis revealed that patients with severe stenosis (narrowing greater than 70%) before DES implantation had a significantly higher perioperative complication rate (10.6%) compared to those with moderate stenosis (1.0%).

The Future of ICAD Treatment: What Does This Mean for You?

This review suggests that drug-eluting stents are a relatively safe and effective option for treating intracranial atherosclerotic disease, offering improved outcomes compared to older stent designs and medical management alone.

However, the increased risk of perioperative complications in patients with severe stenosis highlights the need for careful patient selection and experienced operators. More research is needed to confirm these findings and optimize the use of DES in ICAD.

If you're at risk for or have been diagnosed with ICAD, talk to your doctor about the best treatment options for you. Drug-eluting stents may offer a promising solution, but the decision should be made in consultation with a qualified medical professional who can assess your individual risk factors and determine the most appropriate course of action.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.1016/j.jocn.2018.10.118, Alternate LINK

Title: Efficacy And Safety Of Drug-Eluting Stent For The Intracranial Atherosclerotic Disease: A Systematic Review And Meta-Analysis

Subject: Physiology (medical)

Journal: Journal of Clinical Neuroscience

Publisher: Elsevier BV

Authors: Gengfan Ye, Xiaoliang Yin, Ximeng Yang, Junjie Wang, Peng Qi, Jun Lu, Lijun Wang, Daming Wang

Published: 2019-01-01

Everything You Need To Know

What are drug-eluting stents (DES) and how do they work?

Drug-eluting stents (DES) are a type of stent used to treat intracranial atherosclerotic disease (ICAD). Unlike bare metal stents (BMS), DES release medication over time to prevent the re-narrowing of the artery, known as in-stent restenosis (ISR). This is a significant improvement, because ISR was a major issue with earlier stenting methods.

What is intracranial atherosclerotic disease (ICAD) and why is treating it important?

Intracranial atherosclerotic disease (ICAD) is a condition where arteries within the brain narrow due to a buildup of plaque, which is a major cause of stroke. Traditional treatments for ICAD have limitations. Drug-eluting stents (DES) offer a potential solution by addressing the problem of in-stent restenosis (ISR) and improving outcomes compared to older methods such as bare metal stents (BMS).

What is in-stent restenosis (ISR) and why is it a problem in treating ICAD?

In-stent restenosis (ISR) is the re-narrowing of an artery after a stent has been placed. It occurs because the body's natural healing process can lead to cell growth within the stent. Drug-eluting stents (DES) combat ISR by releasing medication that inhibits this cell growth, thereby keeping the artery open and reducing the risk of future complications.

What were the key findings about drug-eluting stents (DES) from the review?

The analysis of drug-eluting stents (DES) found that perioperative complications occurred in 6.0% of patients, long-term complications in 2.2%, and in-stent restenosis (ISR) in 4.1%. Symptomatic ISR was observed in only 0.5% of patients. Patients with severe stenosis had a higher rate of perioperative complications, underscoring the importance of patient selection.

Are drug-eluting stents (DES) a good treatment option for ICAD?

Drug-eluting stents (DES) are considered a safer and more effective option compared to earlier stent designs and medical management alone for treating intracranial atherosclerotic disease (ICAD). The review suggests that DES are a promising solution for ICAD, improving patient outcomes and reducing complications such as in-stent restenosis (ISR).