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

Zhong-Hao Li,Ya-Wen Chen,Zun-Jing Liu,Zi-Yao Chen,Xian-Jin Zhu,Wei Liu,Zhen-Hua Zhou

doi:10.1155/2017/3258681

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 stroke (RR = 2.15; 95% CI: 1.19–3.89), and intracranial hemorrhage (RR = 14.71; 95% CI: 1.96–110.48) within 30 days in medical therapy alone were lower compared with PTAS plus medical therapy, but there were no significant differences in any stroke and ischemic stroke beyond 30 days between the two groups. There were also no significant differences in any death and myocardial infarction between the two groups. This meta-analysis demonstrated that, compared with medical therapy alone, PTAS for ICAD had a high risk of complication, but most complications in PTAS group occurred within 30 days after the operation, and beyond 30 days the PTAS was not inferior compared with medical therapy alone. Further studies are needed to reduce the periprocedural complications and reappraise the PTAS.

Highlights

Intracranial atherosclerotic disease (ICAD) is a common cause of stroke and associated with a high risk of recurrent stroke [1, 2]
Studies were considered for inclusion if they met the following criteria: (1) all published randomized, controlled trials (RCTs) were comparing percutaneous transluminal angioplasty and stenting (PTAS) plus medical therapy and medical therapy alone and more than 3 patients enrolled in each group; (2) all patients had been treated for an atherosclerotic intracranial stenosis greater than 50% which located in intracranial segment of internal carotid artery, middle cerebral artery, and vertebral or basilar artery; and (3) periprocedural complications were reported
We systematically reviewed any stroke, ischemic stroke, intracranial hemorrhage, any death, myocardial infarction, and so on during follow-up period reported in all the trials

Summary

Introduction

Intracranial atherosclerotic disease (ICAD) is a common cause of stroke and associated with a high risk of recurrent stroke [1, 2]. ICAD is more common in Asians, Hispanics, and those of African descent, compared to Caucasians. It causes approximately 10% of all strokes in the USA [3, 4]. In National Institute of Health-sponsored, multicenter Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial [6], 14% and 23% of the patients with a transient ischemic attack (TIA) or stroke attributable to a highgrade (50–99%) intracranial stenosis had a further ipsilateral ischemic stroke over the year despite medical therapy.

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