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Wang T, Yang K, Zhang X, Luo J, Xu R, Wang X, Yang Y, Bai X, Ma Y, Yan Y, Jiao L. Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis. Transl Stroke Res 2022; 13:676-685. [PMID: 35150413 DOI: 10.1007/s12975-022-00996-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/19/2022]
Abstract
Intracranial artery atherosclerotic stenosis (ICAS) is one of the most common causes of stroke. Endovascular therapy including balloon angioplasty alone (BA), balloon-mounted stent (BMS), or self-expanding stent (SES) was an important alternative to treat symptomatic ICAS refractory to medical treatment, while none of the three subtypes has been established to be the primary option. We conducted a systematic review and network meta-analysis to determine both the safety and efficacy and establish a hierarchy of different endovascular therapies on symptomatic ICAS. Major databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies comparing outcomes of three different endovascular approaches and other comparable non-endovascular therapies for symptomatic ICAS patients published from 1 January 2000 to 1 November 2021. Primary outcomes included short-term mortality or stroke rate (peri-procedural, or mean follow-up ≤ 3 months), and long-term mortality or stroke rate (mean follow-up ≥ 6 months). Pairwise and network meta-analyses based on the above systematic review were conducted. A total of 19 eligible studies involving 3386 patients treated with 4 different approaches (BA, SES, BMS, and medical treatment) were analyzed. For primary outcome, BA had the highest ranking (SUCRA value 78), followed by BMS (SUCRA value 21.5) and SES (SUCRA value 13.1). The short-term mortality or stroke rate was significantly lower in the BA group compared to SES (OR = 2.50; 95% CI 1.12 to 5.57; p = 0.026) or BMS (OR = 0.43; 95% CI 0.19 to 0.96; p = 0.038). Other primary and secondary outcomes were no different among all three types of endovascular therapy. Overall, the studies were of good methodological quality and the consistency was acceptable across all network meta-analyses. BA offers the highest level of safety outcomes in terms of short-term mortality or stroke in treating symptomatic patients with intracranial artery stenosis, compared to SES and BMS, which needs to be confirmed in future studies. Trial registration in PROSPERO database: CRD42018084055.
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Affiliation(s)
- Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Ran Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yutong Yang
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, 100053, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China.
- China International Neuroscience Institute (China-INI), Beijing, 100053, China.
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China.
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100053, China.
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China.
- China International Neuroscience Institute (China-INI), Beijing, 100053, China.
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.
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Abdollahifard S, Yousefi O, Kamran H, Mowla A. Balloon-mounting stent for intracranial arterial stenosis: A comprehensive and comparative systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221100620. [PMID: 35549530 PMCID: PMC10399500 DOI: 10.1177/15910199221100620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION As one of the major causes of acute ischemic stroke, intracranial arterial stenosis necessitates an intervention that ranges from medical treatment to balloon angioplasty and stenting. Self-expandable stents (SES) and balloon-mounted stents (BMS) are two types of stents and their comparative efficacy and safety for intracranial stenosis are not well established. METHODS Studies that investigate balloon-mounted stenting for intracranial stenosis were extracted from PubMed, Scopus, and Cochrane library. We sought to gather data on the success rate, change in mean arterial stenosis, and complications such as minor and major stroke and death (MMD), symptomatic intracranial hemorrhage, myocardial infarction, all-cause mortality, and in-stent re-stenosis. RESULTS 3049 patients from 35 studies were included in this study. 20 studies investigated BMS alone and others compared BMS with SES. BMS was significantly more effective in reducing the degree of stenosis compared to SES (Difference in mean -5.953, CI 95% -7.727 to -4.179), had less complications compared to SES such as MMD (8.5% vs. 11.2%) and less in-stent re-stenosis (18.6% vs. 19.6%), but patients with SES experienced a lower rate of all-cause mortality(1.7% vs. 4.1%). CONCLUSION Intracranial stenting with BMS is more effective in reducing the degree of stenosis and has lower rates of complications when compared to SES.
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Affiliation(s)
- Saeed Abdollahifard
- Research center for neuromodulation and pain, Shiraz, Iran.,Student research committee, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student research committee, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, 5116University of Southern California (USC), Los Angeles, CA, USA
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Henkes H, Bhogal P, Hellstern V, Bäzner H. Endovascular Management of Intracranial Atherosclerotic Stenosis: Lessons from Mistakes in the Past and how to Achieve Improved Outcomes. Clin Neuroradiol 2021; 31:31-34. [PMID: 33751167 PMCID: PMC7943425 DOI: 10.1007/s00062-021-01005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hans Henkes
- Neuroradiologische Klinik, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70194, Stuttgart, Germany. .,Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK
| | - Victoria Hellstern
- Neuroradiologische Klinik, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, 70194, Stuttgart, Germany
| | - Hansjörg Bäzner
- Neurologische Klinik, Katharinenhospital, Klinikum Stuttgart, Kriegsbergstraße 60, Stuttgart, 70194, Germany
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Park SC, Cho SH, Kim MK, Kim JE, Jang WY, Lee MK, Jo KD, You SH. Long-term Outcome of Angioplasty Using a Wingspan Stent, Post-Stent Balloon Dilation and Aggressive Restenosis Management for Intracranial Arterial Stenosis. Clin Neuroradiol 2019; 30:159-169. [PMID: 31123775 DOI: 10.1007/s00062-019-00793-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the long-term outcome of stent angioplasty for symptomatic severe intracranial artery stenosis. METHOD In this study 95 consecutive patients with intracranial atherosclerotic stenosis (>70%) underwent stent angioplasty using Wingspan stents. The primary endpoints were stroke or death within 30 days of the procedure and subsequent stroke attributed to the stented vessel. Disabling stroke was defined as stroke with a modified Rankin scale > 3. Secondary endpoints included transient ischemic attacks, contralateral stroke, nonstroke death, and other events. Patients underwent prestent balloon dilation with or without poststent balloon dilation, close restenosis follow-up, and selective retreatment, as required. RESULT The mean follow-up duration was 34.9 ± 23.3 months. Primary endpoint events occurred in 23% of the patients. The median infarction volume was 2.6 ml, and 11 (68%) of 16 infarctions were <5 ml in volume. Disabling stroke occurred in 3% of patients. The primary endpoint rates were 17.9% within 30 days and 2.1% from 30 days to 1 year. Secondary endpoint events occurred in 27.3% of the patients. Mean stenosis was reduced from 76.8 ± 6.1% to 7.5 ± 13.4%. Of 80 patients who underwent angiographic follow-up, 11 (14%) experienced restenosis (≥50%) and 7 (9%) exhibited restenosis-related symptoms of transient ischemic attack. The rate of symptomatic restenosis was significantly higher in patients who underwent prestent balloon dilation alone than in patients who underwent prestent and poststent balloon dilation (p = 0.016). CONCLUSION The postprocedural stroke rate was similar to that observed in the SAMMPRIS study. Symptomatic restenosis may be reduced by poststent dilation, close angiographic follow-up, and retreatment.
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Affiliation(s)
- Seong-Cheol Park
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, 25440, Gangneung, Gangwon-do, Korea (Republic of)
| | - Su Hee Cho
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, 25440, Gangneung, Gangwon-do, Korea (Republic of)
| | - Moon-Kyu Kim
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, 25440, Gangneung, Gangwon-do, Korea (Republic of)
| | - Ji-Eun Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (Republic of)
| | - Woo-Young Jang
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (Republic of)
| | - Moon-Kyu Lee
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (Republic of)
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (Republic of)
| | - Seung-Hoon You
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Bangdong-gil 38, Sacheon-myeon, 25440, Gangneung, Gangwon-do, Korea (Republic of).
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Bae YJ, Jung C, Kim JH, Choi BS, Kim E, Han MK, Bae HJ, Han MH. Potential for the use of the Solitaire stent for recanalization of middle cerebral artery occlusion without a susceptibility vessel sign. AJNR Am J Neuroradiol 2014; 35:149-55. [PMID: 23744693 DOI: 10.3174/ajnr.a3562] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Absence of the MCA susceptibility vessel sign (negative MCA susceptibility vessel sign) on gradient recalled-echo MR imaging in acute stroke is commonly associated with in situ stenosis and thrombotic occlusion. We evaluated the effectiveness and safety of the Solitaire stent as the first-line device for the recanalization of MCA occlusion with a negative MCA susceptibility vessel sign. MATERIALS AND METHODS Thirty-eight consecutive patients presenting with acute ischemic stroke due to MCA occlusion were treated by using the Solitaire AB stent alone or combined with thrombolytic drugs. Among these patients, 11 (7 men and 4 women; median age, 70 years; range, 49-89 years) who underwent multimodal stroke MR imaging before the endovascular procedure and had no MCA susceptibility vessel sign on the initial gradient recalled-echo MR imaging were included in this study. The primary end point was the recanalization of the occluded artery evaluated by the arterial occlusive lesion score. Clinical outcome was assessed at discharge and 90 days, as was the degree of residual MCA stenosis or reocclusion. RESULTS Successful recanalization (arterial occlusive lesion score ≥ II) without balloon angioplasty was obtained in 9 patients (81.8%). Six patients (54.5%) had an mRS score of ≤2 at 90 days. After a median of 147 days, no patient showed reocclusion on follow-up imaging. There were no symptomatic intracerebral hemorrhages. CONCLUSIONS The Solitaire stent is a feasible tool as the first-line device for multimodal endovascular recanalization therapy in acute ischemic stroke with a negative MCA susceptibility vessel sign. It has a good rate of successful and complete recanalization and is a fast yet safe procedure.
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