Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis

A systematic review and meta-analysis

Georgios Tsivgoulis, Aristeidis H. Katsanos, Georgios Magoufis, Odysseas Kargiotis, Georgios Papadimitropoulos, Konstantinos Vadikolias, Theodoros Karapanayiotides, John Ellul, Anne Alexandrov, Panayiotis D. Mitsias, Andrei Alexandrov

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Objectives: The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach. Methods: We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS. Results: Three RCTs (678 total patients) were included in the quantitative analysis. PTAS was associated with a higher risk of recurrent ischemic stroke in the territory of qualifying artery both within 30 days [risk ratio (RR) = 2.21, 95% confidence interval (CI) 1.10-4.43] and 1 year (RR = 1.92, 95% CI 1.10-3.36). PTAS was also related to a higher risk of any ischemic stroke within 30 days from the index event (RR = 2.08, 95% CI 1.17-3.71). The risk for intracranial hemorrhage was found to be higher in PTAS patients both within 30 days (RR = 10.60, 95% CI 1.98-56.62) and 1 year (RR = 8.15, 95% CI 1.50-44.34). The composite outcome of any stroke or death within 1 year (RR = 2.29, 95% CI 1.13-4.66) and 2 years (RR = 1.52, 95% CI 1.04-2.21) was higher in PTAS than in medical therapy. PTAS was associated with a higher risk of any stroke or death within 2 years in the sICAS subgroup located in posterior circulation (RR = 2.37, 95% CI 1.27-4.42). Conclusions: PTAS is associated with adverse early and long-term outcomes and should not be recommended in patients with sICAS. Further research to identify subgroups of patients who could also serve as candidates for future interventional trials along with efforts to reduce procedure-related complications are needed.

Original languageEnglish (US)
Pages (from-to)351-358
Number of pages8
JournalTherapeutic Advances in Neurological Disorders
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2016

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Angioplasty
Meta-Analysis
Pathologic Constriction
Odds Ratio
Confidence Intervals
Stroke
Randomized Controlled Trials
Safety
Intracranial Hemorrhages
Secondary Prevention
Arteries
Therapeutics
Research

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

Cite this

Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis : A systematic review and meta-analysis. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Magoufis, Georgios; Kargiotis, Odysseas; Papadimitropoulos, Georgios; Vadikolias, Konstantinos; Karapanayiotides, Theodoros; Ellul, John; Alexandrov, Anne; Mitsias, Panayiotis D.; Alexandrov, Andrei.

In: Therapeutic Advances in Neurological Disorders, Vol. 9, No. 5, 01.09.2016, p. 351-358.

Research output: Contribution to journalReview article

Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Magoufis, Georgios ; Kargiotis, Odysseas ; Papadimitropoulos, Georgios ; Vadikolias, Konstantinos ; Karapanayiotides, Theodoros ; Ellul, John ; Alexandrov, Anne ; Mitsias, Panayiotis D. ; Alexandrov, Andrei. / Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis : A systematic review and meta-analysis. In: Therapeutic Advances in Neurological Disorders. 2016 ; Vol. 9, No. 5. pp. 351-358.
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abstract = "Objectives: The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach. Methods: We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS. Results: Three RCTs (678 total patients) were included in the quantitative analysis. PTAS was associated with a higher risk of recurrent ischemic stroke in the territory of qualifying artery both within 30 days [risk ratio (RR) = 2.21, 95{\%} confidence interval (CI) 1.10-4.43] and 1 year (RR = 1.92, 95{\%} CI 1.10-3.36). PTAS was also related to a higher risk of any ischemic stroke within 30 days from the index event (RR = 2.08, 95{\%} CI 1.17-3.71). The risk for intracranial hemorrhage was found to be higher in PTAS patients both within 30 days (RR = 10.60, 95{\%} CI 1.98-56.62) and 1 year (RR = 8.15, 95{\%} CI 1.50-44.34). The composite outcome of any stroke or death within 1 year (RR = 2.29, 95{\%} CI 1.13-4.66) and 2 years (RR = 1.52, 95{\%} CI 1.04-2.21) was higher in PTAS than in medical therapy. PTAS was associated with a higher risk of any stroke or death within 2 years in the sICAS subgroup located in posterior circulation (RR = 2.37, 95{\%} CI 1.27-4.42). Conclusions: PTAS is associated with adverse early and long-term outcomes and should not be recommended in patients with sICAS. Further research to identify subgroups of patients who could also serve as candidates for future interventional trials along with efforts to reduce procedure-related complications are needed.",
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T2 - A systematic review and meta-analysis

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Magoufis, Georgios

AU - Kargiotis, Odysseas

AU - Papadimitropoulos, Georgios

AU - Vadikolias, Konstantinos

AU - Karapanayiotides, Theodoros

AU - Ellul, John

AU - Alexandrov, Anne

AU - Mitsias, Panayiotis D.

AU - Alexandrov, Andrei

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N2 - Objectives: The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach. Methods: We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS. Results: Three RCTs (678 total patients) were included in the quantitative analysis. PTAS was associated with a higher risk of recurrent ischemic stroke in the territory of qualifying artery both within 30 days [risk ratio (RR) = 2.21, 95% confidence interval (CI) 1.10-4.43] and 1 year (RR = 1.92, 95% CI 1.10-3.36). PTAS was also related to a higher risk of any ischemic stroke within 30 days from the index event (RR = 2.08, 95% CI 1.17-3.71). The risk for intracranial hemorrhage was found to be higher in PTAS patients both within 30 days (RR = 10.60, 95% CI 1.98-56.62) and 1 year (RR = 8.15, 95% CI 1.50-44.34). The composite outcome of any stroke or death within 1 year (RR = 2.29, 95% CI 1.13-4.66) and 2 years (RR = 1.52, 95% CI 1.04-2.21) was higher in PTAS than in medical therapy. PTAS was associated with a higher risk of any stroke or death within 2 years in the sICAS subgroup located in posterior circulation (RR = 2.37, 95% CI 1.27-4.42). Conclusions: PTAS is associated with adverse early and long-term outcomes and should not be recommended in patients with sICAS. Further research to identify subgroups of patients who could also serve as candidates for future interventional trials along with efforts to reduce procedure-related complications are needed.

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