Current Status and Future Perspective of Stenting for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis

Abstract

The aim of this study was to evaluate the safety and effectiveness of percutaneous transluminal angioplasty and stenting (PTAS) for intracranial atherosclerotic disease (ICAD) by conducting a meta-analysis. Two independent observers searched PubMed, EMBASE, and Cochrane Library for relevant studies up to 31 December 2016. A meta-analysis was conducted using Review Manager 5.3. Three studies involving 581 cases were included. The meta-analysis indicated that any stroke (RR = 3.13; 95% CI: 1.80-5.42), ischemic stroke (RR = 2.15; 95% CI: 1.19-3.89), and intracranial hemorrhage (RR = 14.71; 95% CI: 1.96-110.48) within 30 days in medical therapy alone were lower compared with PTAS plus medical therapy, but there were no significant differences in any stroke and ischemic stroke beyond 30 days between the two groups. There were also no significant differences in any death and myocardial infarction between the two groups. This meta-analysis demonstrated that, compared with medical therapy alone, PTAS for ICAD had a high risk of complication, but most complications in PTAS group occurred within 30 days after the operation, and beyond 30 days the PTAS was not inferior compared with medical therapy alone. Further studies are needed to reduce the periprocedural complications and reappraise the PTAS.

Figure 1

Flow diagram of the controlled trials reviewed for this meta-analysis.

Figure 2

Quality assessment for included RCTs.

Figure 3

Forest plot of any stroke within 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 4

Forest plot of any stroke beyond 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 5

Forest plot of any stroke between 30 days and 1 year for PTAS plus medical therapy versus medical therapy alone.

Figure 6

Forest plot of any stroke within 1 year for PTAS plus medical therapy versus medical therapy alone.

Figure 7

Forest plot of any stroke during the follow-up for PTAS plus medical therapy versus medical therapy alone.

Figure 8

Forest plot of ischemic stroke within 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 9

Forest plot of ischemic stroke beyond 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 10

Forest plot of ischemic stroke during the follow-up for PTAS plus medical therapy versus medical therapy alone.

Figure 11

Forest plot of intracranial hemorrhage within 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 12

Forest plot of intracranial hemorrhage during follow-up for PTAS plus medical therapy versus medical therapy alone.

Figure 13

Forest plot of death within 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 14

Forest plot of death beyond 30 days for PTAS plus medical therapy versus medical therapy alone.

Figure 15

Forest plot of death between 30 days and 1 year for PTAS plus medical therapy versus medical therapy alone.

Figure 16

Forest plot of death within 1 year for PTAS plus medical therapy versus medical therapy alone.

Figure 17

Forest plot of death during follow-up for PTAS plus medical therapy versus medical therapy alone.

Figure 18

Forest plot of myocardial infarction during follow-up for PTAS plus medical therapy versus medical therapy alone.