Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, 215200, Jiangsu Province, China.
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
J Neurol. 2023 Feb;270(2):662-672. doi: 10.1007/s00415-022-11429-9. Epub 2022 Oct 27.
Recently, several randomized controlled trials (RCTs) of stenting plus medical therapy versus medical therapy alone have been successfully conducted for the treatment of patients with symptomatic intracranial stenosis. This study aimed to evaluate differences between these two therapies in the risk of stroke and death.
MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov were systematically searched to identify relevant studies published before August 24, 2022. Review Manager 5.3 software was used to assess the data. The risk ratio (RR) was analysed and calculated with a random effect model or a fixed effects model.
We pooled 921 participants from three RCTs. Compared to the medical therapy alone group, the stenting plus medical therapy group had a higher risk of 30-day death or stroke (RR = 2.69 [1.64-4.41], P < 0.0001, I = 0%). When the follow-up period exceeded 1 year (≥ 1 year), there was no significant difference in the risk of stroke or death between these two groups. The subgroup analysis showed that if the time from stroke onset to implantation was extended, additional stenting would have no effect on the risk of stroke or death, whether within 30 days or within 1 year (P = 0.16 and 0.78).
Medical therapy alone has a lower risk of stroke and death in the short term than stenting plus medical therapy, while no difference exists in the long term. More studies are still needed to further explore the precision strategy of stent implantation for symptomatic intracranial stenosis patients.
最近，几项支架置入联合药物治疗与单纯药物治疗治疗症状性颅内狭窄患者的随机对照试验（RCT）已成功完成。本研究旨在评估这两种治疗方法在卒中风险和死亡方面的差异。
系统检索 MEDLINE、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov 以确定截至 2022 年 8 月 24 日发表的相关研究。使用 Review Manager 5.3 软件评估数据。采用随机效应模型或固定效应模型分析和计算风险比（RR）。
我们纳入了 3 项 RCT 的 921 名参与者。与单纯药物治疗组相比，支架置入联合药物治疗组 30 天内死亡或卒中风险更高（RR=2.69 [1.64-4.41]，P<0.0001，I²=0%）。当随访时间超过 1 年（≥1 年）时，两组间卒中或死亡风险无显著差异。亚组分析显示，如果将卒中发作到植入的时间延长，额外的支架置入对 30 天内或 1 年内的卒中或死亡风险没有影响（P=0.16 和 0.78）。
短期来看，单纯药物治疗的卒中风险和死亡风险低于支架置入联合药物治疗，而长期来看则无差异。仍需要更多研究进一步探讨症状性颅内狭窄患者支架植入的精准策略。
