Endovascular therapy vs. conventional medical treatment for symptomatic intracranial atherosclerotic stenosis: an updated meta-analysis of randomized controlled trials.
Husam Abu Suilik, Mohammed Baker, Ahmed Naeem, AlMothana Manasrah, Mohamed Elnady, Bashar M Al Zoubi, Mohamed Abouzid, Mohamed Abuelazm
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引用次数: 0
Abstract
Background: Symptomatic intracranial atherosclerotic stenosis is a common cause of ischemic stroke, with high recurrence rates despite medical management. The present study investigated the short-term and long-term outcomes of endovascular therapy (ET) versus conventional medical therapy (CMT) in intracranial atherosclerotic stenosis (sICAS) management.
Methods: We conducted a systematic review and meta-analysis. Searches were performed in PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science (WOS), SCOPUS, and Embase. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. PROSPERO ID: (CRD42024601551).
Results: Five RCTs involving 1,531 patients were included, with 743 in the ET + CMT group and 748 in the CMT group. ET was associated with increased odds of short-term mortality or stroke (OR, 3.19; 95% CI [1.96, 5.19], P < 0.01), including higher risks of mortality (OR, 4.35; 95% CI [1.23, 15.35], P = 0.02), ischemic stroke (OR, 2.26; 95% CI [1.34, 3.82], P < 0.01), and hemorrhagic stroke (OR, 10.74; 95% CI [2.52, 45.90], P < 0.01), but no difference between both groups in transient ischemic attack (OR, 0.87; 95% CI [0.32, 2.34], P = 0.78). For long-term outcomes, no significant differences were observed. However, ET significantly increased long-term hemorrhagic stroke risk (OR, 5.14; 95% CI [1.48, 17.77], P < 0.01).
Conclusion: In patients with ischemic stroke due to sICAS, ET plus CMT has increased the risk of all-cause mortality, ischemic stroke, and hemorrhagic stroke compared to CMT alone. Hence, current evidence does not support adjuvant ET for patients with sICAS.
背景:症状性颅内动脉粥样硬化性狭窄是缺血性脑卒中的常见原因,尽管有药物治疗,但复发率很高。本研究调查了血管内治疗(ET)与常规药物治疗(CMT)在颅内动脉粥样硬化性狭窄(sICAS)治疗中的短期和长期结果。方法:我们进行了系统综述和荟萃分析。在PubMed (MEDLINE)、Cochrane Central Register of Controlled Trials (Central)、Web of Science (WOS)、SCOPUS和Embase中进行检索。计算95%置信区间(ci)的比值比(ORs)。普洛斯彼罗id:(crd42024601551)。结果:纳入5项随机对照试验,共1531例患者,其中ET + CMT组743例,CMT组748例。ET与短期死亡或卒中的几率增加相关(or, 3.19; 95% CI [1.96, 5.19], P)结论:在sICAS所致缺血性卒中患者中,与单独CMT相比,ET加CMT增加了全因死亡率、缺血性卒中和出血性卒中的风险。因此,目前的证据不支持sICAS患者的辅助ET。
期刊介绍:
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.