Dmytriw Adam A, Ku Jerry, Azzam Ahmed Y, Elamin Osman, Cancelliere Nicole, Kapadia Anish, Rabinov James D, Stapleton Christopher J, Regenhardt Robert W, Pereira Vitor Mendes, Patel Aman B, Yang Victor X D
Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA.
Neurovascular Centre, Departments of Medical Imaging & Surgery, Sunnybrook Health Sciences Centre and St. Michael's Hospital, University of Toronto, Toronto ON, Canada.
J Cerebrovasc Endovasc Neurosurg. 2024 Jun;26(2):152-162. doi: 10.7461/jcen.2023.E2023.03.002. Epub 2023 Nov 29.
Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS.
The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022.
This Meta-analysis Included Four Randomized Controlled Trials (Rcts), With A Total Number Of 991 Patients. The Mean Age Of Participants Was 57 Years. The Total Number Of Intracranial Stenting Patients Was 495, And The Number Of Medical Treatment Patients Was 496. The Included Studies Were Published Between 2011 And 2022. Two Studies Were Conducted In The Usa, And The Other Two In China. All Included Studies Compared Intracranial Stenting To Medical Treatment For Icas.
In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.
中风是全球第二大致死原因。颅内动脉粥样硬化性狭窄（ICAS）在西方国家的缺血性中风中占10%-15%，在亚洲国家高达47%。ICAS患者中风复发风险特别高。本荟萃分析的目的是重新评估有症状ICAS患者支架置入术与最佳药物治疗相比的复发性中风、短暂性脑缺血发作（TIA）及其他结局。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南预先制定检索方案。检索了OVID Medline、Embase、Web of Science和Cochrane图书馆数据库，检索时间从建库至2022年8月14日。
本荟萃分析纳入四项随机对照试验（RCT），共991例患者。参与者的平均年龄为57岁。颅内支架置入患者总数为495例，药物治疗患者数为496例。纳入的研究发表于2011年至2022年之间。两项研究在美国进行，另外两项在中国进行。所有纳入研究均比较了ICAS的颅内支架置入术与药物治疗。
对于有症状的严重颅内动脉粥样硬化所致缺血性中风患者，30天缺血性中风、30天脑出血、1年内责任区域中风或死亡率方面，单纯药物治疗而非颅内支架置入更具优势。末次随访时责任区域中风风险、末次随访时致残性中风及死亡率在两组间无显著差异。动脉粥样硬化的颅内支架置入术相比药物治疗未带来显著益处。
