Abuzinadah Ahmad R, Alanazy Mohammed H, Almekhlafi Mohammed A, Duan Yanjune, Zhu Haifeng, Mazighi Mikael, Lutsep Helmi L, Donnon Tyrone, Hill Michael D
Internal Medicine Department, King Abdulaziz University, Jeddah, KSA.
Internal Medicine Department, King Saud University, Riyadh, KSA.
J Neurointerv Surg. 2016 Feb;8(2):112-6. doi: 10.1136/neurintsurg-2014-011458. Epub 2014 Dec 11.
A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study.
We conducted a systematic review and meta-analysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates.
23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95% CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95% CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95% CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95% CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 person-years (95% CI 5.5 to 9.0) in the endovascular group.
Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.
近期一项针对主要为前循环颅内动脉狭窄患者的随机试验表明，在预防复发性卒中方面，强化药物治疗优于颅内支架置入术。单纯药物治疗的症状性颅内椎基底动脉狭窄患者的卒中复发或死亡率可能特别高，与血管内治疗相比的比率需要进一步研究。
我们对报告症状性颅内椎基底动脉狭窄患者接受药物或血管内治疗且至少随访6个月的卒中复发或死亡率（主要结局）的研究进行了系统评价和荟萃分析。我们纳入了MEDLINE或EMBASE索引的任何语言的所有研究，并通过文献检索和联系作者进行补充。次要终点是卒中复发、基底动脉和椎动脉卒中复发率。
纳入了23项研究（592例药物治疗患者和480例血管内治疗患者）。药物治疗组卒中复发或死亡的合并风险为每100人年14.8例（95%CI 9.5至20.1），而血管内治疗组为每100人年8.9例（95%CI 6.9至11.0）。发病率比为1.3（95%CI 1.0至1.7）。药物治疗组的卒中复发率为每100人年9.6例（95%CI 5.1至14.1），而血管内治疗组为每100人年7.2例（95%CI 5.5至9.0）。
我们的结果表明，药物治疗组和血管内治疗组之间的卒中复发或死亡风险或单独的卒中复发风险相当。血管内治疗可能存在微小的预防作用，特别是如果术后30天的风险降低。
