BioMed Research International

2017

DOI: 10.1155/2017/3258681

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Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

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Abstract: The aim of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD) by conducting a meta-analysis. Two independent observers searched PubMed, EMBASE, and Cochrane Library for relevant studies up to 31 December 2016. A meta-analysis was conducted using Review Manager 5.3. Three studies involving 581 cases were included. The meta-analysis indicated that any stroke (RR = 3.13; 95% CI: 1.80–5.42), ischemic s… Show more

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Cited by 5 publications

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“…A meta-analysis published in 2017 compared the effects of applying PTAS and drug therapy to patients with Symptomatic Intracranial Atherosclerotic Disease [30]. The results showed that medical therapy was superior to PTAS within 30 days, and there was no statistical difference between those beyond 30 days, which was similar to the results of this study.…”

Section: Discussionsupporting

confidence: 85%

Effect of percutaneous transluminal angioplasty and stenting vs aggressive medical management on Risk of Stroke and Death in Patients with stroke or intracranial atherosclerotic stenosis: a systematic review and meta-analysis

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et al. 2023

Preprint

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Background: There are currently two treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical management (AMM). However, the choice between PTAS or AMM remains controversial for patients with stroke or intracranial atherosclerotic stenosis (ICAS). Methods: The investigators searched PubMed, Web of Science, Embase, Scopus, and Cochrane library databases. Randomized controlled trial (RCT) comparing the PTAS and AMM for patients with stroke or ICAS were selected. RevMan 5.3 was used to analyze the results and risk of bias. The primary endpoints are stroke and death within 30 days after enrollment, or ischemic stroke in the territory of the qualifying artery beyond 30 days, and entire follow-up endpoints. The secondary outcomes were the disabling or fatal stroke, and incidence of death within 3 years. Results: Four studies, 989 patients were included in this article. The AMM group was superior in the entire follow-up endpoint (OR: 0.56; 95% CI: 0.40, 0.79). The AMM also better in primary endpoint within 30 days (OR: 0.32; 95% CI: 0.17, 0.61). There was no significant difference beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86). The remaining outcomes, such as stroke and death, were not significantly different (P>0.05). Conclusion: This meta-analysis shows AMM is significantly more effective than PTAS in subjects with ICAS because of the high rate of periprocedural OR: 0.32; 95% CI: 0.17, 0.61) and entire follow-up (OR: 0.56; 95% CI: 0.40, 0.79) stroke from PTAS and the fact that PTAS offers no benefit over AMM beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86).

“…A meta-analysis published in 2017 compared the effects of applying PTAS and drug therapy to patients with Symptomatic Intracranial Atherosclerotic Disease [30]. The results showed that medical therapy was superior to PTAS within 30 days, and there was no statistical difference between those beyond 30 days, which was similar to the results of this study.…”

Section: Discussionsupporting

confidence: 85%

Effect of percutaneous transluminal angioplasty and stenting vs aggressive medical management on Risk of Stroke and Death in Patients with stroke or intracranial atherosclerotic stenosis: a systematic review and meta-analysis

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²

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³

et al. 2023

Preprint

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Background: There are currently two treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical management (AMM). However, the choice between PTAS or AMM remains controversial for patients with stroke or intracranial atherosclerotic stenosis (ICAS). Methods: The investigators searched PubMed, Web of Science, Embase, Scopus, and Cochrane library databases. Randomized controlled trial (RCT) comparing the PTAS and AMM for patients with stroke or ICAS were selected. RevMan 5.3 was used to analyze the results and risk of bias. The primary endpoints are stroke and death within 30 days after enrollment, or ischemic stroke in the territory of the qualifying artery beyond 30 days, and entire follow-up endpoints. The secondary outcomes were the disabling or fatal stroke, and incidence of death within 3 years. Results: Four studies, 989 patients were included in this article. The AMM group was superior in the entire follow-up endpoint (OR: 0.56; 95% CI: 0.40, 0.79). The AMM also better in primary endpoint within 30 days (OR: 0.32; 95% CI: 0.17, 0.61). There was no significant difference beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86). The remaining outcomes, such as stroke and death, were not significantly different (P>0.05). Conclusion: This meta-analysis shows AMM is significantly more effective than PTAS in subjects with ICAS because of the high rate of periprocedural OR: 0.32; 95% CI: 0.17, 0.61) and entire follow-up (OR: 0.56; 95% CI: 0.40, 0.79) stroke from PTAS and the fact that PTAS offers no benefit over AMM beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86).

“…The irregular use of antithrombotic treatment may be the cause of the high recurrent of stroke. For patients with symptomatic intracranial atherosclerotic disease, aggressive medical therapy is needed [52]. Rehabilitation can reduce the risk of adverse effects such as medical morbidity and psychological illness [53].…”

Section: Discussionmentioning

confidence: 99%

Stem cell-based therapies for ischemic stroke: a systematic review and meta-analysis of clinical trials

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et al. 2020

Stem Cell Res Ther

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Recently, extensive researches about stem cell-based therapies for ischemic stroke have been published; our review evaluated the efficacy and safety of stem cell-based therapies for ischemic stroke. Our review was registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number CRD42019135805. Two independent observers searched PubMed, EMBASE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), and Web of Science (Science Citation Index Expanded) for relevant studies up to 31 May 2019. We included clinical trials which compared efficacy outcomes (measured by National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), or Barthel index (BI)) and safety outcomes (such as death and adverse effects) between the stem cell-based therapies and control in ischemic stroke. We performed random effect meta-analysis using Review Manager 5.3. Our review included nine randomized controlled trials (RCTs) and seven non-randomized studies (NRSs), involving 740 participants. Stem cell-based therapies were associated with better outcomes measured by NIHSS (mean difference (MD) − 1.63, 95% confidence intervals (CI) − 2.73 to − 0.53, I 2 =60%) and BI (MD 14.68, 95% CI 1.12 to 28.24, I 2 = 68%) in RCTs, and by BI (MD 6.40, 95% CI 3.14 to 9.65, I 2 = 0%) in NRSs. However, the risk of bias was high and the efficacy outcomes of RCTs were high heterogeneity. There was no significant difference in mortality between the stem cell group and the control group. Fever, headache, and recurrent stroke were the most frequently reported adverse effects. Our review shows that stem cell-based therapies can improve the neurological deficits and activities of daily living in patients with ischemic stroke.

“…A meta-analysis published in 2017 compared the effects of applying PTAS and drug therapy to patients with Symptomatic Intracranial Atherosclerotic Disease 43 . The results showed that medical therapy was superior to PTAS within 30 days, and there was no statistical difference between those beyond 30 days, which was similar to the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transluminal angioplasty and stenting vs aggressive medical management on stroke or intracranial atherosclerotic stenosis: a systematic review and meta-analysis

¹

,

²

,

³

et al. 2023

View full text Add to dashboard Cite

There are currently two main treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical management (AMM). However, the choice between PTAS or AMM remains controversial for patients with stroke or intracranial atherosclerotic stenosis (ICAS). The investigators searched the PubMed, Web of Science, Embase, Scopus, and Cochrane library databases. Randomized controlled trial (RCT) comparing PTAS and AMM for patients with stroke or ICAS were selected. RevMan 5.3 was used to analyze the results and assess risk of bias. The primary endpoints are stroke and death within 30 days after enrollment, or ischemic stroke in the territory of the qualifying artery beyond 30 days, and entire follow-up endpoints. The secondary outcomes were the disabling or fatal stroke, and incidence of death within 3 years. Four studies, 989 patients were included in this article. The AMM group was superior in the entire follow-up endpoint (OR 0.56; 95% CI 0.40, 0.79). The AMM also better in primary endpoint within 30 days (OR 0.32; 95% CI 0.17, 0.61). There was no significant difference beyond 30 days (OR 1.08; 95% CI 0.63, 1.86). The remaining outcomes, such as stroke and death, were not significantly different (P > 0.05). This meta-analysis shows AMM is significantly more effective than PTAS in subjects with ICAS due to the high rate of periprocedural stroke (OR 0.32; 95% CI 0.17, 0.61) and stroke during the entire follow-up (OR 0.56; 95% CI 0.40, 0.79) associated with PTAS. Furthermore, PTAS offers no additional benefits over AMM beyond 30 days (OR 1.08; 95% CI 0.63, 1.86).

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