Abstract TP202: Safety and Efficacy of Drug-Eluting Stents in Intracranial Atherosclerotic Disease: A Systematic Review and Meta-Analysis

Abstract

Background: Advancements in arterial stenting technology have challenged prior notions favoring medical management over endovascular intervention for intracranial atherosclerotic disease (ICAD). Where previous conclusions were drawn from bare metal stent (BMS) technology, recent studies suggest drug-eluting stents (DES) are favorable over BMS due to their anti-proliferative effect. Methods: We conducted a systematic review and meta-analysis of the literature prior to August 2023 reviewing reports of ICAD treated with DES. Our target outcomes were incidence of any stroke, transient ischemic attack (TIA), or death within 30 days (post-procedural complications), ischemic stroke in the territory of the qualifying artery beyond 30 days (long-term complications), radiographically detected in-stent restenosis rate (ISR), and symptomatic ISR during follow-up. A subgroup analysis further stratified pre-procedural mean stenosis above and below 70% into severe and moderate cohorts, respectively. Results: PubMed and EMBASE query identified 518 candidate articles, from which 13 studies met inclusion criteria for a total of 475 patients and 508 ICAD lesions. Incidence of post-procedural complications was 8.1% (95% CI 3.1-15.1%) with subgroup analysis demonstrating significantly higher incidence in the severely stenotic group [10.4% (95% CI 5.7%-16.2%)] than the moderately stenotic group [3.0% (95% CI 0.7%- 6.8%)]. Long-term complications were 1.2% (95% CI 0.4%-2.4%). Radiographic ISR was 3.2% (95% CI 1.0%- 6.5%) and symptomatic ISR was 0.0% (95% CI 0.0%-0.5%). Conclusions: Our systematic review and meta-analysis suggest that DES can effectively reduce the risk of ISR and may be a viable treatment modality to reduce long-term complications in refractory ICAD patients.