Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Intracranial stenting compared to medical treatment alone for intracranial atherosclerosis patients: An updated meta-analysis

  • Adam A. Dmytriw (Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School) ;
  • Jerry Ku (Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto) ;
  • Ahmed Y. Azzam (Nested Knowledge, Department of Neuroradiology, Mayo Clinic) ;
  • Osman Elamin (Nested Knowledge, Department of Neuroradiology, Mayo Clinic) ;
  • Nicole Cancelliere (Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto) ;
  • Anish Kapadia (Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto) ;
  • James D. Rabinov (Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School) ;
  • Christopher J. Stapleton (Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School) ;
  • Robert W. Regenhardt (Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School) ;
  • Vitor Mendes Pereira (Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto) ;
  • Aman B. Patel (Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School) ;
  • Victor X.D. Yang (Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto)
  • Received : 2023.03.04
  • Accepted : 2023.09.08
  • Published : 2024.06.30
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Abstract

Objective: Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS. Methods: The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022. Results: This meta-analysis included four randomized controlled trials (RCTs), with a total number of 991 patients. The mean age of participants was 57 years. The total number of intracranial stenting patients was 495, and the number of medical treatment patients was 496. The included studies were published between 2011 and 2022. Two studies were conducted in the USA, and the other two in China. All included studies compared intracranial stenting to medical treatment for ICAS. Conclusions: In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.

Keywords

References

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