Abstract 3: Stent Placement versus Best Medical Therapy for Symptomatic Intracranial Stenosis. A Meta-analysis of Randomized and Non-randomized Studies

Abstract

Objective: There is controversy regarding the role of stent placement for the treatment of symptomatic intracranial stenosis. Several small trials have inconclusively compared the efficacy of stent placement with medical therapy in patients with symptomatic intracranial stenosis. We therefore conducted a meta-analysis to evaluate the clinical efficacy and safety of intracranial stent placement relative to best medical therapy in patients with symptomatic intracranial stenosis. Methods: We assessed risk of bias and overall quality of the included trials. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using random-effects models. Study end points were the proportion of subjects who had ischemic stroke, any stroke and transient ischemic stroke in qualifying artery. The safety end points were the proportion of subjects who had symptomatic intracerebral hemorrhage (sICH) and mortality. Results: A total of 1029 patients were analyzed of whom 453 were treated with intracranial stent placement in three randomized trials and three non randomized studies . sICH was significantly higher in patients who underwent intracranial stent placement (OR 5.85, 95% CI 1.86-18.34, P= .002) than among those who received medical therapy. Stroke in qualifying artery during follow-up was also significantly higher in subjects who underwent intracranial stent placement than among those who received medical therapy (OR 2.08, 95%CI 1.31-3.32, P= .002). There was no difference in mortality and transient ischemic stroke in qualifying artery among subjects who received intracranial stent compared with those who received medical therapy, (OR 0.83, 95%CI 0.38-1.83, P= .65 & OR 0.78, 95%CI 0.29-2.11, P= .63), respectively. Conclusion: Modification in techniques of intracranial stent placement are required to reduce the rates of sICH and stroke in qualifying artery to provide benefit over best medical treatment.