Stenting Plus Medical Therapy versus Medical Therapy Alone in Patients With Symptomatic Intracranial Stenosis: A Systematic Review and Meta-Analysis
Gabriel Marinheiro Dos Santos-Bezerra1, Carlos Alberto Campello Jorge2, Mariana Sakiyama3, Pedro Amatto4, EVERTON CASTANHA5, Artur Menegaz2, Daniel Schachter6
1Federal University of Ceará, 2Federal University of Mato Grosso, 3State University of Oeste do Paraná, 4University of Ribeirão Preto, 5Federal University of Pelotas, 6Federal University of Rio de Janeiro
Objective:
We aimed to perform a systematic review and meta-analysis on the clinical outcomes of stenting plus medical therapy versus medical therapy alone, on patients with severe symptomatic intracranial stenosis (>70%).
Background:
Intracranial stenosis is one of the most common causes of stroke and is associated with a high risk of recurrent stroke. However, there has been considerable debate about the safety and efficacy of angioplasty with stenting in this group of patients.
Design/Methods:
PubMed, EMBASE, and Cochrane databases were searched for studies comparing medical therapy with or without angioplasty and stenting. Studies were excluded if stenoses were predominantly vertebrobasilar. Medical therapy was defined as the use of dual antiplatelet therapy and the treatment of risk factors/comorbidities.
Results:
Six studies were included, with 1278 patients, of whom 45.2% underwent angioplasty with stenting. There was no significant difference between groups in mortality (RR 1.27; 95% CI 0.53-3.09; p=0.59); ischemic stroke (RR 0.9; 95% CI 0.44-1.83; p=0.78); and ischemic stroke in the same territory (RR 1.33; 95% CI 0.68-2.59; p=0.41). Intracranial hemorrhage within 30 days was significantly higher in patients who underwent stenting (RR 8.29; 95% CI 2.72-25.32; p=0.0002). In a subanalysis restricted to randomized studies, there was no difference between groups in mortality (RR 1.92; 95% CI 0.73-5.08; p=0.19) or ischemic stroke in the same territory (RR 1.53; 95% CI 0.83-2.83; p=0.18). In randomized studies, there was also a higher incidence of intracranial hemorrhage in the interventional group within 30 days (RR 13.49; 95% CI 2.59-70.15; p=0.002).
Conclusions:
In this meta-analysis, there was no difference in stroke recurrence and mortality between patients treated with stenting or medical therapy alone, but there was a significantly higher rate of hemorrhagic stroke within 30 days in the stenting group.