Intracranial angioplasty with a self-expandable stent for intracranial atherosclerotic stenosis: Systematic review and meta-analysis

Abstract

BackgroundIntracranial angioplasty with a self-expandable stent (SES) is an important endovascular therapy for symptomatic intracranial arterial stenosis. We sought to update the evaluation of the perioperative safety and long-term outcomes of self-expandable stent for the treatment of symptomatic intracranial arterial stenosis.MethodsWe comprehensively searched the published literature from each database through Sept 16, 2022, for the PubMed, EMBASE, Web of Science, Cochrane, and Clinical Trials databases. The characteristics of the studies and patients, perioperative complications, and long-term outcomes were extracted. The pooled outcomes and 95% confidence intervals (CIs) were estimated by Stata Statistical Software 14.0.ResultsA total of 4,632 patients from 58 studies were included. The pooled rate of perioperative stroke or death was 6.32% (95% CI 5.04-7.72%); ischemic stroke beyond 30 days through 1 year was 2.72% (95% CI 1.41–4.38%). Perioperative complications differed between the 2014-2022 and 2005-2013 subgroups, as did long-term outcomes between the off-label SES and Wingspan subgroups.ConclusionThe perioperative complications of intracranial angioplasty with SES have been reduced, but the risk of perioperative stroke or death is still higher than that of aggressive medical therapy, and additional studies are needed to determine whether it has better long-term outcomes than aggressive medical therapy. Perioperative complications varied between the 2014-2022 and 2005-2013 subgroups, as did long-term outcomes between the off-label SES and Wingspan subgroups. Given the high level of heterogeneity observed between the included studies, these results should be interpreted with caution and additional studies are needed.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022316066.

Complications and long-term in-stent restenosis of endovascular treatment of severe symptomatic intracranial atherosclerotic stenosis and relevant risk factors

“…Severe symptomatic intracranial atherosclerotic stenosis is an important cause of ischemic stroke and can be treated with medications and stent angioplasty. [1][2][3][4] Pharmacological therapies are ineffective for high grade stenosis or occlusion of intracranial arteries and cannot prevent future strokes in patients who have experienced a transient neurological deficit or minor stroke from an intracranial stenotic lesion. Intracranial stenting for severe stenosis has been performed widely and achieved a great success [1,2,[4][5][6][7][8] even though a recent study (SAMMPRIS) of stenting versus aggressive medications for preventing recurrent ischemic stroke in intracranial stenosis disencourages the use of the Wingspan stent (Stryker Neurovascular, Kalamazoo, LY and HD contributed equally to this work.…”

“…[ 1 – 4 ] Pharmacological therapies are ineffective for high grade stenosis or occlusion of intracranial arteries and cannot prevent future strokes in patients who have experienced a transient neurological deficit or minor stroke from an intracranial stenotic lesion. Intracranial stenting for severe stenosis has been performed widely and achieved a great success [ 1 , 2 , 4 – 8 ] even though a recent study (SAMMPRIS) of stenting versus aggressive medications for preventing recurrent ischemic stroke in intracranial stenosis disencourages the use of the Wingspan stent (Stryker Neurovascular, Kalamazoo, MI) for intracranial stenosis because of concern with high rates of periprocedural stroke and death in the stenting arm. [ 9 , 10 ] Moreover, in-stent restenosis may occur after percutaneous transluminal angioplasty and stenting in patients with intracranial atherosclerotic stenosis, and postoperative in-stent restenosis has been reported to range 2.38% to 26.7% at follow-up months after stenting.…”