Endovascular therapy versus best medical treatment for symptomatic intracranial atherosclerotic stenosis: A systematic review and meta-analysis.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-03-13 DOI:10.1177/23969873251324863

Maria-Ioanna Stefanou, Evangelos Panagiotopoulos, Lina Palaiodimou, Aikaterini Theodorou, George Magoufis, Stavros Spiliopoulos, Apostolos Safouris, Odysseas Kargiotis, Klearchos Psychogios, Tatiana Sidiropoulou, Frantzeska Frantzeskaki, Panayiotis D Mitsias, Katharina Feil, Annerose Mengel, Marios Themistocleous, Ulf Ziemann, Georgios Tsivgoulis

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引用次数: 0

Abstract

Introduction: Evidence on endovascular therapy (EVT) for symptomatic intracranial stenosis (sICAS) from randomized-controlled clinical trials (RCTs) is conflicting. While prior RCTs on percutaneous transluminal angioplasty and stenting (PTAS) demonstrated harm or no benefit over best medical treatment (BMT), recent data suggest that submaximal balloon angioplasty with BMT may be superior to BMT alone.

Patients and methods: A systematic review and meta-analysis of RCTs was conducted to evaluate the safety and efficacy of elective EVT plus BMT compared to BMT alone for sICAS.

Results: Six RCTs (5 on PTAS and 1 on balloon-angioplasty) comprising 1606 patients were included. EVT increased the risk of any stroke or death (RR = 2.68; 95% CI: 1.72-4.19; I² = 0%), ischemic stroke within the territory of the qualifying artery (RR = 2.51; 95% CI: 1.36-4.61; I² = 0%), any ischemic stroke (RR = 1.99; 95% CI: 1.17-3.38; I² = 0%), intracranial hemorrhage (RR = 6.23; 95% CI: 1.92-20.2; I² = 0%), and mortality (RR = 3.52; 95% CI: 1.04-11.88; I² = 0%) within 30 days. No significant benefit from EVT was detected regarding the risk of any stroke or death (RR = 0.29, 95% CI: 0.06-1.38; I² = 68%), ischemic stroke in the territory of the qualifying artery (RR = 0.44, 95% CI: 0.14-1.33; I² = 59%) and mortality (RR = 0.49, 95% CI: 0.16-1.55; I² = 0%) beyond 30 days through 1 year.

Discussion and conclusion: EVT is associated with adverse early outcomes, without reducing the risk of long-term stroke recurrence or mortality compared to BMT. Further research is warranted to identify high-risk subgroups who may benefit from EVT for sICAS and refine interventions to minimize periprocedural risks.

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血管内治疗与最佳药物治疗对症颅内动脉粥样硬化性狭窄：系统回顾和荟萃分析。

导论：来自随机对照临床试验（RCTs）的血管内治疗（EVT）治疗症状性颅内狭窄（sICAS）的证据是相互矛盾的。虽然先前关于经皮腔内血管成形术和支架植入术（PTAS）的随机对照试验表明，与最佳药物治疗（BMT）相比，PTAS有弊或无利，但最近的数据表明，亚最大球囊血管成形术联合BMT可能优于单独的BMT。患者和方法：对随机对照试验进行了系统回顾和荟萃分析，以评估选择性EVT + BMT治疗sICAS的安全性和有效性，与单独BMT相比。结果：共纳入6项随机对照试验（PTAS 5项，球囊血管成形术1项），共1606例患者。EVT增加任何中风或死亡的风险(RR = 2.68；95% ci: 1.72-4.19；I2 = 0%)，合格动脉范围内缺血性卒中(RR = 2.51；95% ci: 1.36-4.61；I2 = 0%)，任何缺血性卒中(RR = 1.99；95% ci: 1.17-3.38；I2 = 0%)，颅内出血(RR = 6.23；95% ci: 1.92-20.2；I2 = 0%)，死亡率(RR = 3.52；95% ci: 1.04-11.88；I2 = 0%)在30天内。EVT在卒中或死亡风险方面未发现显著益处(RR = 0.29, 95% CI: 0.06-1.38；I2 = 68%)，合格动脉区域缺血性卒中(RR = 0.44, 95% CI: 0.14-1.33；I2 = 59%)和死亡率(RR = 0.49, 95% CI: 0.16—-1.55;I2 = 0%)超过30天，直到1年。讨论和结论：与BMT相比，EVT与不良的早期预后相关，不能降低长期卒中复发或死亡的风险。需要进一步的研究来确定可能受益于EVT治疗sICAS的高危亚组，并改进干预措施以尽量减少围手术期风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.