Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis

Wang, Tao; Yang, Kun; Zhang, Xiao; Luo, Jichang; Ren, Xu; Wang, Xue; Yang, Yutong; Bai, Xuesong; Ma, Yan; Yan, Yuxiang

doi:10.1007/s12975-022-00996-8

Cited by 12 publications

(6 citation statements)

References 48 publications

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“…Wang et al conducted a systematic review to analyze three endovascular intervention methods for the treatment of patients with sICAS: Balloon angioplasty, balloon-mounted stenting, and self-expanding stent placement. The ndings revealed that balloon angioplasty signi cantly reduced short-term risks of stroke and death compared to the latter two methods (perioperative or ≤ 3 months postoperative) 23 . A meta-analysis comparing medical treatment, stent placement, and balloon angioplasty for sICAS indicated that, during long-term follow-ups, balloon angioplasty might be the most effective method for preventing strokes and reducing mortality 24 .…”

Section: Discussionmentioning

confidence: 95%

Safety Assessment of Symptomatic Intracranial Atherosclerotic Stenosis: A Comparison between Sole Balloon Angioplasty and Medical Treatment

Cao,

Wen,

Cao

et al. 2024

Preprint

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Patients with symptomatic intracranial arterial stenosis (sICAS) will likely face perioperative risks with stent placement and recurrence with medication. Simple balloon angioplasty (SBA), as a less invasive and safer alternative to stent placement, may offer an effective treatment option for sICAS. This study aimed to assess the perioperative safety of SBA compared to medication for sICAS. A retrospective analysis was conducted on sICAS patients admitted to the Department of Neurology, Jiangxi Provincial People's Hospital, between January 2020 and December 2021, within 60 days of onset. Patients with severe stenosis (70% to 99% rate), confirmed by cerebral angiography, were divided into medication and SBA groups. Demographic data, medical history, NIH Stroke Scale (NIHSS) scores at onset, responsible vessels, degree of vascular stenosis, postoperative residual stenosis rate, and any stroke or death within 30 days postoperatively were assessed. The study included 91 patients, with 51 in the medication group (38 males, mean age 58.06±1.58 years) and 40 in the SBA group (24 males, mean age 60.95±1.37 years). There were no significant differences in demographics, medical history, NIHSS scores, or degree of vascular stenosis (all P > 0.05). All SBA patients underwent successful balloon angioplasty, with 8 cases (20%) requiring a stent placement due to significant post-dilation stenosis regression or dissection affecting blood flow. Within 30 days postoperatively, 2 patients (3.9%) in the medication group experienced progressive stroke, while 3 patients (7.5%) in the SBA group experienced endpoint events, including 2 cases of new-onset infarction and 1 case of subarachnoid hemorrhage. There was no statistically significant difference in endpoint event occurrence between the groups (P > 0.05), and no deaths occurred. In conclusion, SAB in sICAS patients did not significantly increase the risk of stroke within 30 days postoperatively compared to medication treatment. Long-term efficacy warrants further investigation.

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Section: Discussionmentioning

confidence: 95%

Safety Assessment of Symptomatic Intracranial Atherosclerotic Stenosis: A Comparison between Sole Balloon Angioplasty and Medical Treatment

Cao,

Wen,

Cao

et al. 2024

Preprint

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“…36,37 Subsequently, PTAS involved self-expanding stent (SES) and balloon-mounted stent (BMS) has been extensively investigated, and the high technical success rate and relatively low risk of complications and restenosis are acceptable in many studies (Table 5). Recent meta-analysis studies showed that: compared to SES, BMS was more effective in reducing the degree of stenosis (Difference in mean −5.953, CI 95% −7.727 to −4.179), and has lower rates of complications (8.5% vs. 11.2%) and ISR (18.6% vs. 19.6%), but higher rate of all-cause mortality (1.7% vs. 4.1%) in treating sICAS 38 ; PTBA offers the highest level of safety outcomes in terms of short-term mortality or stroke, compared to SES (OR = 2.50; 95% CI 1.12 to 5.57; p = 0.026) and BMS (OR = 0.43; 95% CI 0.19 to 0.96; p = 0.038). 39 Even so, these results needs to be confirmed in future studies, and the optimal strategy of procedure for sICAS has not yet been determined.…”

Section: Discussionmentioning

confidence: 95%

Short-term outcome of stenting with Enterprise stents for symptomatic intracranial atherosclerotic disease at a single center

Zhou

et al. 2022

Interv Neuroradiol

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Objective To evaluate the safety and efficacy of stenting for symptomatic intracranial atherosclerotic severe stenosis or occlusion with Enterprise stents. Methods Fifty-three consecutive patients with symptomatic intracranial atherosclerotic severe (70%–99%) stenosis or occlusion who underwent endovascular treatment with Enterprise stents between September 2019 and March 2022 were retrospectively analyzed. Primary outcomes included technical stenting success rates, the incidence of complications within 30 days of the procedure, and the in-stent restenosis rates during the follow-up period. These outcomes were further categorized based on lesion location and operation time. Results Fifty-seven lesions in 53 patients aged 61.0 ± 10.0 years were treated with Enterprise stents with a technical success rate of 100%. Seven patients (12.3%) had severe complications within 30 days of the procedure: five had a symptomatic ischemic stroke, one had a symptomatic intracerebral hemorrhage, and one had a subarachnoid hemorrhage related to the procedure. No deaths were observed. The rate of in-stent restenosis was 18.2%, with a mean vascular imaging follow-up period of 6.7 months. The 30-day complication and in-stent restenosis rates did not differ significantly between patients with different lesion locations and operation times ( P > 0.05). Conclusion This retrospective study suggests that percutaneous transluminal angioplasty and stenting with Enterprise stents is an effective treatment for symptomatic intracranial arterial stenosis or occlusion with a high technical success rate. It also indicates that stenting during the early nonacute stage after stroke may not increase the incidence of perioperative complications for symptomatic intracranial atherosclerotic stenosis when following strict inclusion criteria.

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“…Despite more frequent postoperative residual stenosis, 15 PTA alone may offer higher short-term safety and comparable long-term mortality and stroke rate compared with SES or BMS. 16 In the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, the occurrence of stroke or death in the PTA with SES group was significantly higher than the medical group at 30 days (14.7% vs 5.8%, p=0.0016) and at 3 years (23.9% vs 14.9%, p=0.0193). 17 Similarly, the Vitesse Intracranial Stent Study for Ischemic Stroke Therapy (VISSIT) trial demonstrated that aggressive medical therapy alone was superior to BMS for patients with ICAS and was terminated owing to safety concerns about high adverse event rates within 30 days in the stenting group (24.1%).…”

Section: Introductionmentioning

confidence: 99%

“…PTA alone can apply pressure to the stenotic artery wall through balloon dilation, effectively dilating the lumen and restoring blood supply. Despite more frequent postoperative residual stenosis,15 PTA alone may offer higher short-term safety and comparable long-term mortality and stroke rate compared with SES or BMS 16. In the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, the occurrence of stroke or death in the PTA with SES group was significantly higher than the medical group at 30 days (14.7% vs 5.8%, p=0.0016) and at 3 years (23.9% vs 14.9%, p=0.0193) 17.…”

Section: Introductionmentioning

confidence: 99%

Comparison of drug-coated balloon angioplasty versus standard medical therapy on recurrent stroke and mortality rates among patients with symptomatic intracranial atherosclerotic stenosis: protocol for a systematic review and meta-analysis

Sun,

Luo,

Gong

et al. 2023

BMJ Open

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IntroductionStroke remains the second leading cause of death worldwide, a common cause of which is intracranial atherosclerotic stenosis (ICAS). Medical treatment is recommended as first-line therapy for treating ICAS, but the recurrence rate remains high. Drug-coated balloon (DCB) angioplasty has been designed to lower the risk of recurrent stenosis, holding therapeutic promise in the treatment of ICAS. However, the benefits of DCB require further evaluation.Methods and analysisThe Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols was followed to develop this protocol. We will systematically search online databases including Cochrane Central Register of Controlled Trials, PubMed, Web of Science, EMBASE, China Biological Medicine Database, ClinicalTrials.gov and WHO ICTRP from 1 January 2011 to the date of search. This will be supplemented by a manual search of unpublished and ongoing trials to manually select articles for inclusion. Inclusion criteria are randomised or quasi-randomised clinical trials and observational studies that investigated DCB or medical treatment for patients with a symptomatic ICAS of 50%–99%. The primary outcome is short-term composite safety including death of any cause, or non-fatal stroke. Secondary outcomes include long-term death or stroke, restenosis, neurological rehabilitation, quality of life and other complications. The available data will be analysed using meta-analysis, if appropriate. The evaluation of heterogeneity and biases will be guided by the Cochrane Handbook for Systematic Reviews of Interventions.Ethics and disseminationThis systematic review does not require ethical approval as all available data from eligible studies will be anonymous with no concerns regarding privacy. Our findings will be disseminated through international conferences and peer-reviewed publications. Additional data from the study are available on request to corresponding authors via email.PROSPERO registration numberCRD42022341607.

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Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis

Cited by 12 publications

References 48 publications

Safety Assessment of Symptomatic Intracranial Atherosclerotic Stenosis: A Comparison between Sole Balloon Angioplasty and Medical Treatment

Safety Assessment of Symptomatic Intracranial Atherosclerotic Stenosis: A Comparison between Sole Balloon Angioplasty and Medical Treatment

Short-term outcome of stenting with Enterprise stents for symptomatic intracranial atherosclerotic disease at a single center

Comparison of drug-coated balloon angioplasty versus standard medical therapy on recurrent stroke and mortality rates among patients with symptomatic intracranial atherosclerotic stenosis: protocol for a systematic review and meta-analysis

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