球囊血管成形术与支架置入术治疗有症状的颅内动脉狭窄
Balloon Angioplasty vs. Stenting for Symptomatic Intracranial Arterial Stenosis.
作者信息
Sun Yaxuan, Li Xihua, Ding Yongxia, Han Bin, Wang Jing, Meng Kun, Han Yan
机构信息
Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China.
The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China.
出版信息
Front Neurol. 2022 Jun 14;13:878179. doi: 10.3389/fneur.2022.878179. eCollection 2022.
AIMS
We performed a meta-analysis to indirectly compare the treatment effectiveness of balloon angioplasty and stenting for patients with intracranial arterial stenosis.
METHODS
Literature searches were performed in well-known databases to identify eligible studies published before January 04, 2021. The incidence of restenosis, transient ischemic attack (TIA), stroke, death, and dissection after balloon angioplasty or stenting were pooled. An indirect comparison of balloon angioplasty vs. stenting was performed, and the ratios of incidence (RIs) with 95% confidence intervals (CIs) were calculated using the random-effects model.
RESULTS
120 studies that recruited 10,107 patients with intracranial arterial stenosis were included. The pooled incidence of restenosis after balloon angioplasty and stenting were 13% (95%CI: 8-17%) and 11% (95%CI: 9-13%), respectively, with no significant difference between them (RI: 1.18; 95%CI: 0.78-1.80; = 0.435). Moreover, the pooled incidence of TIA after balloon angioplasty and stenting was 3% (95%CI: 0-6%) and 4% (95%CI: 3%-5%), and no significant difference was observed (RI: 0.75; 95%CI: 0.01-58.53; = 0.897). The pooled incidence of stroke after balloon angioplasty and stenting was 7% (95%CI: 5-9%) and 8% (95%CI: 7-9%), respectively, and the difference between groups was found to be statistically insignificant (RI: 0.88; 95%CI: 0.64-1.20; = 0.413). Additionally, the pooled incidence of death after balloon angioplasty and stenting was 2% (95%CI: 1-4%) and 2% (95%CI: 1-2%), with no significant difference between groups (RI: 1.00; 95%CI: 0.44-2.27; = 1.000). Finally, the pooled incidence of dissection after balloon angioplasty and stenting was 13% (95%CI: 5-22%) and 3% (95%CI: 2-5%), respectively, and balloon angioplasty was associated with a higher risk of dissection than that with stenting for patients with intracranial arterial stenosis (RI: 4.33; 95%CI: 1.81-10.35; = 0.001).
CONCLUSION
This study found that the treatment effectiveness of balloon angioplasty and stenting were similar for patients with symptomatic intracranial arterial stenosis.
目的
我们进行了一项荟萃分析，以间接比较球囊血管成形术和支架置入术对颅内动脉狭窄患者的治疗效果。
方法
在知名数据库中进行文献检索，以确定2021年1月4日前发表的符合条件的研究。汇总球囊血管成形术或支架置入术后再狭窄、短暂性脑缺血发作（TIA）、中风、死亡和夹层的发生率。对球囊血管成形术与支架置入术进行间接比较，并使用随机效应模型计算95%置信区间（CI）的发生率比值（RI）。
结果
纳入了120项研究，共10107例颅内动脉狭窄患者。球囊血管成形术和支架置入术后再狭窄的汇总发生率分别为13%（95%CI：8-17%）和11%（95%CI：9-13%），两者之间无显著差异（RI：1.18；95%CI：0.78-1.80；P = 0.435）。此外，球囊血管成形术和支架置入术后TIA的汇总发生率分别为3%（95%CI：0-6%）和4%（95%CI：3%-5%），未观察到显著差异（RI：0.75；95%CI：0.01-58.53；P = 0.897）。球囊血管成形术和支架置入术后中风的汇总发生率分别为7%（95%CI：5-9%）和8%（95%CI：7-9%），组间差异无统计学意义（RI：0.88；95%CI：0.64-1.20；P = 0.413）。此外，球囊血管成形术和支架置入术后死亡的汇总发生率分别为2%（95%CI：1-4%）和2%（95%CI：1-2%），组间无显著差异（RI：1.00；95%CI：0.44-2.27；P = 1.000）。最后，球囊血管成形术和支架置入术后夹层的汇总发生率分别为13%（95%CI：5-22%）和3%（95%CI：2-5%），对于颅内动脉狭窄患者，球囊血管成形术比支架置入术有更高的夹层风险（RI：4.33；95%CI：1.81-10.35；P = 0.001）。
结论
本研究发现，对于有症状的颅内动脉狭窄患者，球囊血管成形术和支架置入术的治疗效果相似。
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