Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, UK.
BMJ Open. 2018 Jul 10;8(7):e022359. doi: 10.1136/bmjopen-2018-022359.
Atherosclerotic intracranial artery stenosis (ICAS) is one of most common causes of stroke, which is the second-leading cause of death worldwide. Medical, surgical and endovascular therapy are three major treatments for ICAS. Currently, medical therapy is considered as the standard of care for most patients with ICAS, while extracranial to intracranial bypass is only used in rare situations. Balloon angioplasty alone, balloon-mounted stent and self-expanding stent, collectively called endovascular treatment, have shown promising potentials in treating specific subgroups of patients with symptomatic ICAS; however, their comparative safety and efficacy is still unclear. Therefore, a systematic review with network meta-analysis is needed to establish a hierarchy of these endovascular treatments.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was followed to establish this protocol. The search will be limited to studies published from 1 January 2000 to the formal search date. Major databases including Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, conference proceedings and grey literature database will be searched for clinical studies comparing at least two interventions for patients with symptomatic ICAS. Primary outcomes include short-term and long-term mortality or stroke rate. Random effects pairwise and network meta-analyses of included studies will be performed on STATA (V.14, StataCorp, 2015). The surface under the cumulative ranking curve and mean rank will be calculated in order to establish a hierarchy of the endovascular treatments. Evaluation of the risk of bias, heterogeneity, consistency, transitivity and quality of evidence will follow the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions.
Ethics approval is not needed as systematic review is based on published studies. Study findings will be presented at international conferences and published on a peer-reviewed journal.
CRD42018084055; Pre-results.
动脉粥样硬化性颅内动脉狭窄（ICAS）是中风最常见的原因之一，也是全球范围内第二大致死原因。医学、手术和血管内治疗是治疗 ICAS 的三种主要方法。目前，医学治疗被认为是大多数 ICAS 患者的标准治疗方法，而颅外-颅内旁路仅在极少数情况下使用。单纯球囊血管成形术、球囊扩张支架和自膨式支架，统称为血管内治疗，已显示出在治疗有症状的 ICAS 特定亚组患者方面有很大的潜力；然而，它们的安全性和疗效比较仍不清楚。因此，需要进行系统评价和网络荟萃分析，以确定这些血管内治疗方法的优先级。
本方案遵循系统评价和荟萃分析的首选报告项目制定。检索将限于 2000 年 1 月 1 日至正式检索日期发表的研究。主要数据库包括 Cochrane 图书馆、MEDLINE、EMBASE、中国生物医学文献数据库、会议论文集和灰色文献数据库，将对比较至少两种干预措施治疗有症状的 ICAS 患者的临床研究进行检索。主要结局包括短期和长期死亡率或卒中发生率。将对纳入的研究进行 STATA（V.14，StataCorp，2015）的随机效应成对和网络荟萃分析。将计算累积排序曲线下面积和平均秩，以确定血管内治疗方法的优先级。将根据 Cochrane 干预系统评价手册的建议评估偏倚风险、异质性、一致性、可传递性和证据质量。
由于系统评价基于已发表的研究，因此不需要伦理批准。研究结果将在国际会议上报告，并在同行评议的期刊上发表。
PROSPERO 注册号：CRD42018084055；预结果。
