Stenting Plus Medical Therapy versus Medical Therapy Alone in Patients With Symptomatic Intracranial Stenosis: A Systematic Review and Meta-Analysis (P8-5.009)

Abstract

<h3>Objective:</h3> We aimed to perform a systematic review and meta-analysis on the clinical outcomes of stenting plus medical therapy versus medical therapy alone, on patients with severe symptomatic intracranial stenosis (&gt;70%). <h3>Background:</h3> Intracranial stenosis is one of the most common causes of stroke and is associated with a high risk of recurrent stroke. However, there has been considerable debate about the safety and efficacy of angioplasty with stenting in this group of patients. <h3>Design/Methods:</h3> PubMed, EMBASE, and Cochrane databases were searched for studies comparing medical therapy with or without angioplasty and stenting. Studies were excluded if stenoses were predominantly vertebrobasilar. Medical therapy was defined as the use of dual antiplatelet therapy and the treatment of risk factors/comorbidities. <h3>Results:</h3> Six studies were included, with 1278 patients, of whom 45.2% underwent angioplasty with stenting. There was no significant difference between groups in mortality (RR 1.27; 95% CI 0.53–3.09; p=0.59); ischemic stroke (RR 0.9; 95% CI 0.44–1.83; p=0.78); and ischemic stroke in the same territory (RR 1.33; 95% CI 0.68–2.59; p=0.41). Intracranial hemorrhage within 30 days was significantly higher in patients who underwent stenting (RR 8.29; 95% CI 2.72–25.32; p=0.0002). In a subanalysis restricted to randomized studies, there was no difference between groups in mortality (RR 1.92; 95% CI 0.73–5.08; p=0.19) or ischemic stroke in the same territory (RR 1.53; 95% CI 0.83–2.83; p=0.18). In randomized studies, there was also a higher incidence of intracranial hemorrhage in the interventional group within 30 days (RR 13.49; 95% CI 2.59–70.15; p=0.002). <h3>Conclusions:</h3> In this meta-analysis, there was no difference in stroke recurrence and mortality between patients treated with stenting or medical therapy alone, but there was a significantly higher rate of hemorrhagic stroke within 30 days in the stenting group. <b>Disclosure:</b> Mr. Dos Santos-Bezerra has nothing to disclose. Dr. Campello Jorge has nothing to disclose. Ms. Sakiyama has nothing to disclose. Mr. Amatto has nothing to disclose. Mr. CASTANHA has nothing to disclose. Mr. Menegaz de Almeida has nothing to disclose. Mr. Schachter has nothing to disclose.