Keisuke Kadooka1, Niels Hagenbuch2, Vania Anagnostakou3, Anton Valavanis3, Zsolt Kulcsár3. 1. Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091 Switzerland; Department of Neurosurgery, Kameda Medical Center, Higashi-cho 929, Kamogawa, 296-8602 Chiba, Japan. Electronic address: kadosan0313@ybb.ne.jp. 2. Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001 Switzerland. 3. Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091 Switzerland.
Abstract
BACKGROUND AND PURPOSE: Endovascular treatment is offered for symptomatic intracranial stenosis (ICS) when medical therapy fails. The purpose of this meta-analysis is to evaluate the risks and effectiveness of balloon angioplasty (BA) alone. MATERIALS AND METHODS: Systematic review and meta-analysis of all available articles on BA for symptomatic ICS was conducted. Data was analyzed separately for > 70% (Group 1) and > 50% (Group 2) stenosis. The results of the Group 1 were compared with those of SAMMPRIS study to the extent possible. RESULTS: A total of 25 studies comprising 674 patients were included. The cumulative incidence of periprocedural (within 30 days) stroke and death were 16.3% (Group 1), 7.6% (Group 2) and 11.5% (all studies). Incidence rates of ischemic stroke in the qualifying artery territory during follow-up (per 100 patient-years) were 2.0, 2.4 and 2.3, any stroke and death during follow-up were 4.4, 7.4 and 6.9, restenosis rates were 4.9, 11.5 and 8.9 respectively. While comparison of cumulative incidences of periprocedural ischemic stroke between Group 1 (13.0%) and the medical arm from SAMMPRIS study(4.4%) showed a significant difference (P = 0.008), there was no significant difference between the Group 1 and the stenting arm from SAMMPRIS study(10.7%) in the same variable. CONCLUSION: Balloon angioplasty for stenosis of more than 70% is likely to have similar outcome comparable to the stenting arm in the SAMMPRIS study, however it presents lower rates of late ischemic events and restenosis. These data may help deciding on the endovascular method of choice in case of medical therapy failure.
BACKGROUND AND PURPOSE: Endovascular treatment is offered for symptomatic intracranial stenosis (ICS) when medical therapy fails. The purpose of this meta-analysis is to evaluate the risks and effectiveness of balloon angioplasty (BA) alone. MATERIALS AND METHODS: Systematic review and meta-analysis of all available articles on BA for symptomatic ICS was conducted. Data was analyzed separately for > 70% (Group 1) and > 50% (Group 2) stenosis. The results of the Group 1 were compared with those of SAMMPRIS study to the extent possible. RESULTS: A total of 25 studies comprising 674 patients were included. The cumulative incidence of periprocedural (within 30 days) stroke and death were 16.3% (Group 1), 7.6% (Group 2) and 11.5% (all studies). Incidence rates of ischemic stroke in the qualifying artery territory during follow-up (per 100 patient-years) were 2.0, 2.4 and 2.3, any stroke and death during follow-up were 4.4, 7.4 and 6.9, restenosis rates were 4.9, 11.5 and 8.9 respectively. While comparison of cumulative incidences of periprocedural ischemic stroke between Group 1 (13.0%) and the medical arm from SAMMPRIS study(4.4%) showed a significant difference (P = 0.008), there was no significant difference between the Group 1 and the stenting arm from SAMMPRIS study(10.7%) in the same variable. CONCLUSION:Balloon angioplasty for stenosis of more than 70% is likely to have similar outcome comparable to the stenting arm in the SAMMPRIS study, however it presents lower rates of late ischemic events and restenosis. These data may help deciding on the endovascular method of choice in case of medical therapy failure.
Authors: Tanya N Turan; Osama O Zaidat; Gary S Gronseth; Marc I Chimowitz; Antonio Culebras; Anthony J Furlan; Larry B Goldstein; Nestor R Gonzalez; Julius G Latorre; Steven R Messé; Thanh N Nguyen; Rajbeer S Sangha; Michael J Schneck; Aneesh B Singhal; Lawrence R Wechsler; Alejandro A Rabinstein; Mary Dolan O'Brien; Heather Silsbee; Jeffrey J Fletcher Journal: Neurology Date: 2022-03-22 Impact factor: 9.910