The Effect of Intensive Medical and Endovascular Therapy vs Medical Therapy Alone on the Incidence of Stroke and Death in Patients with Symptomatic Intracranial Artery Stenosis: A Meta-Analysis of Randomized Clinical Trials
Hussnain Ahmed Osto1, Amna Binte Naeem1, Maheen Shaharyar1, Haroon Shabbir1, Muaz Ali2, Mubashir Pervez3
1Rawalpindi Medical University, 2Holy Family Hospital, 3Cleveland Clinic
Objective:

To determine the Effect of Intensive Medical and Endovascular Therapy vs Medical Therapy alone on the incidence of Stroke and Death in patients with intracranial arterial stenosis through a meta-analysis.

Background:

Intracranial arterial stenosis is a major risk factor for ischemic stroke. Currently available clinical trials suggest varying outcomes related to the incidence of stroke and death following management of symptomatic Intracranial Artery Stenosis. We attempted to consolidate clinical trials on the matter and improve the level of evidence by conducting a meta-analysis.

Design/Methods:

We systematically searched PubMed, Cochrane, and Clinicaltrials.gov databases for randomized clinical trials reporting the incidence of stroke and mortality following Endovascular Plus Medical Therapy vs. Medical Therapy Alone for the management of intracranial arterial stenosis. Included studies employed endovascular procedures including submaximal balloon angioplasty, balloon-expandable intracranial stenting, and percutaneous transluminal angioplasty. Medical therapy included aspirin (81-325 mg daily) and clopidogrel (75 mg daily) for 90 days after enrollment.

Results:

Our search yielded five clinical trials which were included in the meta-analysis. We pooled two primary outcome measures i.e. incidence of stroke/death within 30 days or within and after 30 days of enrollment. An increased incidence of stroke/death within 30 days of enrollment was seen in the Endovascular Plus Medical Therapy Group vs. Medical Therapy Alone group (OR: 2.66; 95% CI: 1.66, 4.26; p<0.0001; I² = 0%). The results were not statistically significant for incidence of stroke/death both within and beyond 30 days (OR: 1.11; 95% CI: 0.52, 2.40; p = 0.79; I² = 81%).

Conclusions:

Recent trials have demonstrated improved effectiveness of endovascular methods for intracranial atherosclerotic stenosis, which may be attributed to improved devices, techniques, and advanced management of this etiology of stroke. However, the risk of stroke and death, especially within the first 30 days following endovascular procedures, is noteworthy, and further trials on this topic are warranted.

10.1212/WNL.0000000000212027
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