Drug-eluting stent versus bare metal stent for symptomatic intracranial stenosis: a comparative systematic review and meta-analysis study.

IF 2.4 3区医学 Q3 PHARMACOLOGY & PHARMACY

European Journal of Clinical Pharmacology Pub Date : 2025-05-06 DOI:10.1007/s00228-025-03846-2

Mohammad Sina Mirjani, Pouria Delbari, Muhammad Hussain Ahmadvand, Saba Sabet, Zahra Ardestani, Mohammad Emad Sharifi, Sina Hatami, Mansoureh Jabari, Amirali Barkhordarioon, Mohammad Taha Akbari Javar, Amirmohammad Bahri, Sina Ahmadi, Bardia Hajikarimloo, Ibrahim Mohammadzadeh, Mohammad Amin Habibi, Hamidreza Saber

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引用次数: 0

Abstract

Background: Intracranial atherosclerotic artery stenosis (ICAS) is a major cause of ischemic stroke globally and is associated with poor recanalization rates, high recurrence, and adverse functional outcomes. The use of stents has been explored as a treatment option to improve outcomes, despite concerns over procedure-related complications and in-stent restenosis (ISR). This study aimed to compare the efficacy and safety of drug-eluting stents (DES) versus bare metal stents (BMS) in treating patients with symptomatic ICAS (sICAS).

Method: A systematic review and meta-analysis were conducted according to PRISMA guidelines, with a comprehensive search of PubMed, Embase, and Web of Science up to March 1, 2024. Studies that reported outcomes such as technical and clinical success rates, periprocedural complications, ISR, and stroke rates were included. Statistical analysis was performed using Stata v.17.

Results: A total of 44 studies involving 13,658 patients were included. DES demonstrated lower pooled rates of major stroke (3% [95% CI 2-4%]) and ISR (8% [95% CI 3-12%]) compared to BMS (5% [95% CI 3-6%] for major stroke and 19% [95% CI 14-24%] for ISR), though the difference in major stroke rate was not statistically significant. The clinical success rate was similar between DES (89% [95% CI 78-99%]) and BMS (86% [95% CI 76-97%]). Technical success rates were high and comparable for both stent types. Subgroup analyses and meta-regression identified significant factors influencing heterogeneity, including stent or wire length and diameter.

Conclusion: DES showed a significant advantage over BMS in reducing ISR and major stroke rates while maintaining comparable safety and technical success. These findings support the preferential use of DES in clinical practice for managing sICAS, emphasizing their role in enhancing patient outcomes through reduced restenosis and recurrent ischemic events.

查看原文本刊更多论文

药物洗脱支架与裸金属支架治疗症状性颅内狭窄：一项比较系统评价和荟萃分析研究。

背景：颅内动脉粥样硬化性狭窄（ICAS）是全球缺血性卒中的主要原因，与再通率低、复发率高和不良功能预后相关。尽管存在手术相关并发症和支架内再狭窄（ISR）的担忧，但仍在探索使用支架作为改善预后的治疗选择。本研究旨在比较药物洗脱支架（DES）与裸金属支架（BMS）治疗症状性ICAS （sICAS）患者的疗效和安全性。方法：根据PRISMA指南，综合检索PubMed、Embase和Web of Science截止到2024年3月1日的文献，进行系统综述和meta分析。研究报告了技术和临床成功率、围手术期并发症、ISR和卒中发生率等结果。采用Stata v.17进行统计分析。结果：共纳入44项研究，13658例患者。与BMS相比，DES显示出较低的主要卒中合并发生率（3% [95% CI 2-4%]）和ISR合并发生率（8% [95% CI 3-12%]）（主要卒中合并发生率为5% [95% CI 3-6%]， ISR合并发生率为19% [95% CI 14-24%]），尽管主要卒中发生率差异无统计学意义。DES （89% [95% CI 78-99%]）和BMS （86% [95% CI 76-97%]）的临床成功率相似。两种支架的技术成功率都很高且具有可比性。亚组分析和meta回归确定了影响异质性的重要因素，包括支架或金属丝的长度和直径。结论：与BMS相比，DES在降低ISR和主要卒中发生率方面具有显著优势，同时保持了相当的安全性和技术成功。这些发现支持在临床实践中优先使用DES来治疗sICAS，强调它们通过减少再狭窄和复发性缺血事件来提高患者预后的作用。

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 Journal of Clinical Pharmacology 医学-药学

CiteScore

5.40

自引率

3.40%

发文量

170

审稿时长

3-8 weeks

期刊介绍： The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.