Endovascular treatment for symptomatic intracranial artery stenosis: protocol for a systematic review and network meta-analysis

Abstract

IntroductionAtherosclerotic intracranial artery stenosis (ICAS) is one of most common causes of stroke, which is the second-leading cause of death worldwide. Medical, surgical and endovascular therapy are three major treatments for ICAS. Currently, medical therapy is considered as the standard of care for most patients with ICAS, while extracranial to intracranial bypass is only used in rare situations. Balloon angioplasty alone, balloon-mounted stent and self-expanding stent, collectively called endovascular treatment, have shown promising potentials in treating specific subgroups of patients with symptomatic ICAS; however, their comparative safety and efficacy is still unclear. Therefore, a systematic review with network meta-analysis is needed to establish a hierarchy of these endovascular treatments.Methods and analysisThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was followed to establish this protocol. The search will be limited to studies published from 1 January 2000 to the formal search date. Major databases including Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, conference proceedings and grey literature database will be searched for clinical studies comparing at least two interventions for patients with symptomatic ICAS. Primary outcomes include short-term and long-term mortality or stroke rate. Random effects pairwise and network meta-analyses of included studies will be performed on STATA (V.14, StataCorp, 2015). The surface under the cumulative ranking curve and mean rank will be calculated in order to establish a hierarchy of the endovascular treatments. Evaluation of the risk of bias, heterogeneity, consistency, transitivity and quality of evidence will follow the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.Ethics and disseminationEthics approval is not needed as systematic review is based on published studies. Study findings will be presented at international conferences and published on a peer-reviewed journal.PROSPERO registration numberCRD42018084055; Pre-results.

Stenting for Symptomatic Intracranial Vertebrobasilar Artery Stenosis in Northeast of China: A Single-Center Study

“…Posterior circulation stroke takes ~25% of all ischemic stroke cases, and unlike anterior stroke, symptomatic vertebrobasilar atherosclerotic disease is more challenging and has a relatively higher annual recurrence of stroke despite standard medical treatment of antiplatelet agents and statin ( 1 – 3 ), and the symptoms caused by large artery stenosis or occlusion are often devastating. Also, it was associated with a risk of stroke > 20%, as was shown in a pooled data analysis from two studies ( 4 , 5 ). Stenting is becoming a promising therapeutic method for recurrent ischemic events refractory to best medical treatment, but there are also side effects such as procedure-related ischemic stroke or transient ischemic attack (TIA), intracranial hemorrhage, and even death ( 6 , 7 ).…”

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

“…Second, we did a Bayesian network analysis by using Markov chain Monte Carlo methods via GeMTC package 0.8 implemented in R 3.2.2. We also assessed study design information and patient characteristics to evaluate the transitivity assumption for reliable data pooling with sufficient similarity between the included trials [18, 19]. Both non-informative uniform and normal prior distributions were used throughout the network meta-analysis [20].…”

Treatment strategies for asymptomatic carotid artery stenosis in the era of lipid-lowering drugs: protocol for a systematic review and network meta-analysis

“…36 Carotid artery stenosis caused by other reasons, including vasculitis, fibromuscular dysplasia, Moyamoya disease, vasospasm and dissection will not be included. 37…”

“…Primary and secondary outcomes will be compared in this NMA. 37 Primary outcomes 1. Mortality, stroke or MI rates in the periprocedural period or during the postoperative period of 30 days.…”

“…In case of any duplicated studies, group discussion to identify the study providing the most valuable information for final analysis will be held. According to a previously published pilot test, 37 we will adopt a revised form as shown in online supplementary 3 for the reviewers to calculate inter-rater reliability and ensure high agreement (≥80%) when performing screening. If there was any disagreement or discrepancies between the two reviewers in the screening process, discussion or consultation with a third reviewer will be conducted.…”