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Ther Adv Neurol Disord. 2016 Sep;9(5):351-8. doi: 10.1177/1756285616650357. Epub 2016 May 23.

Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis: a systematic review and meta-analysis.

Author information

1
Second Department of Neurology, University of Athens, Iras 39, Gerakas Attikis, Athens, 15344, Greece.
2
Second Department of Neurology, 'Attikon'Hospital, School of Medicine, University of Athens, Athens, Greece Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
3
Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
4
Second Department of Neurology, 'Attikon' Hospital, School of Medicine, University of Athens, Athens, Greece.
5
Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece.
6
Second Department of Neurology, Aristotelian University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
7
Department of Neurology, University of Patras, Patras, Greece.
8
Australian Catholic University, Sydney, Australia.
9
Department of Neurology, Henry Ford Hospital Detroit, Michigan Department of Neurology, Medical School, University of Crete, Heraklion, Crete, Greece.
10
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.

Abstract

OBJECTIVES:

The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach.

METHODS:

We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS.

RESULTS:

Three RCTs (678 total patients) were included in the quantitative analysis. PTAS was associated with a higher risk of recurrent ischemic stroke in the territory of qualifying artery both within 30 days [risk ratio (RR) = 2.21, 95% confidence interval (CI) 1.10-4.43] and 1 year (RR = 1.92, 95% CI 1.10-3.36). PTAS was also related to a higher risk of any ischemic stroke within 30 days from the index event (RR = 2.08, 95% CI 1.17-3.71). The risk for intracranial hemorrhage was found to be higher in PTAS patients both within 30 days (RR = 10.60, 95% CI 1.98-56.62) and 1 year (RR = 8.15, 95% CI 1.50-44.34). The composite outcome of any stroke or death within 1 year (RR = 2.29, 95% CI 1.13-4.66) and 2 years (RR = 1.52, 95% CI 1.04-2.21) was higher in PTAS than in medical therapy. PTAS was associated with a higher risk of any stroke or death within 2 years in the sICAS subgroup located in posterior circulation (RR = 2.37, 95% CI 1.27-4.42).

CONCLUSIONS:

PTAS is associated with adverse early and long-term outcomes and should not be recommended in patients with sICAS. Further research to identify subgroups of patients who could also serve as candidates for future interventional trials along with efforts to reduce procedure-related complications are needed.

KEYWORDS:

ischemic stroke; percutaneous transluminal angioplasty; stenting; symptomatic intracranial arterial stenosis

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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