Comparing Stenting with Medical Therapy Versus Medical Therapy Alone in Patients with Intracranial Atherosclerotic Stenosis: A Current Systematic Review and Meta-Analysis.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Khalid Bin Aziz, Hussam Alhathlol, Fahad Bin Aziz, Mohammed Alshammari, Mohammed Ali Alhefdhi, Abdulrahman M Alrasheed, Nawwaf Alfayez, Thamer S Alhowaish
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Abstract

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk-benefit calculus such as the promising use of balloon angioplasty in the BASIS trial.

颅内动脉粥样硬化性狭窄患者支架置入术与单纯药物治疗的比较:一项系统综述和荟萃分析
背景:颅内动脉粥样硬化性狭窄(ICAS)是世界范围内缺血性卒中的一个重要原因,尽管有最佳的药物治疗,但复发率很高。虽然血管内支架植入术已被提议作为一种辅助治疗,但其作为一线治疗的临床益处仍存在争议。目的:通过随机对照试验(RCTs)的系统回顾和荟萃分析,评价支架置入加药物治疗(STN+MT)与单纯药物治疗(MT)在症状性ICAS患者中的疗效和安全性。方法:我们系统地检索PubMed, Web of Science, Cochrane Library, Embase, Scopus和EBSCO,以比较STN+MT与MT在成年症状性ICAS患者中的rct。主要结局包括短暂性脑缺血发作(TIA)、中风、脑出血(ICH)和30天和1年的死亡。采用随机效应或固定效应模型计算95%置信区间的合并风险比。meta回归通过研究水平的特征来评估效果的改变。结果:纳入4项试验,990例患者。与单纯MT相比,STN+MT与30天卒中和脑出血风险显著升高相关。1年后,两组在TIA、卒中、脑出血或死亡方面无显著差异。meta回归显示没有显著的影响因子,表明亚组间的结果一致。结论:我们的荟萃分析巩固了颅内支架置入术作为一线治疗在预防症状性ICAS患者卒中方面没有明显优势的证据,但它确实增加了早期风险。这在不同的试验、患者统计数据和临床情况下都是正确的。这一信息在多个随机对照试验中的一致性为指导实践提供了高水平的证据。目前,积极的药物治疗应该是大多数患者的默认管理。血管内干预应保留给临床试验环境或精心挑选的抢救病例,除非出现新的证据来改变风险-收益计算,如在BASIS试验中有希望使用球囊血管成成术。
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
Clinics and Practice
Clinics and Practice MEDICINE, GENERAL & INTERNAL-
CiteScore
2.60
自引率
4.30%
发文量
91
审稿时长
10 weeks
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