Li Tianhua, Luo Jichang, Bai Xuesong, Almallouhi Eyad, Gao Peng, Liu Delin, Xu Ran, Xu Wenlong, Lu Guangdong, Gong Haozhi, Zhang Xiao, Lu Taoyuan, Wang Jie, Yang Renjie, Xing Zixuan, Liu Guangjie, Dai Yufu, Derdeyn Colin P, Jiao Liqun, Wang Tao
Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China.
Neuro Interventional Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Stroke Vasc Neurol. 2025 Aug 26;10(4):422-430. doi: 10.1136/svn-2024-003532.
The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) relative to medical management in treating symptomatic intracranial arterial stenosis (ICAS) varies based on the qualifying artery. This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery (ICA), middle cerebral artery (MCA), vertebral artery (VA) and basilar artery (BA).
This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials, evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries. The primary outcome was stroke or death within 30 days postenrolment, or stroke in the region of the qualifying artery beyond 30 days through 1 year. A methodology based on intention-to-treat was employed, and HR accompanied by 95% CIs were used to convey risk estimates.
The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial. Four hundred were designated for PTAS, while 409 were assigned to medical therapy alone. For the primary outcome, patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy (17.17% vs 7.77%; 9.40; HR, 2.38 (1.03 to 5.52); p=0.04). However, PTAS had no significant difference in patients with symptomatic ICA (26.67% vs 16.67%; HR, 1.68 (0.78 to 3.62); p=0.19), MCA (8.28% vs 9.79%; HR, 0.85 (0.42 to 1.74); p=0.66) and VA stenosis (9.52% vs 10.71%; HR, 0.91 (0.32 to 2.62); p=0.86) compared with medical therapy.
PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis. Without significant technological advancements to mitigate these risks, PTAS offers limited benefits. For symptomatic ICA, MCA and VA stenosis, PTAS provided no significant advantage.
经皮腔内血管成形术和支架置入术（PTAS）相对于药物治疗在治疗症状性颅内动脉狭窄（ICAS）方面的疗效因符合条件的动脉不同而有所差异。本研究旨在评估在涉及颈内动脉（ICA）、大脑中动脉（MCA）、椎动脉（VA）和基底动脉（BA）的ICAS病例中，PTAS与单纯药物治疗的比较。
本研究对来自两项随机对照试验的个体患者数据进行了全面的汇总分析，评估PTAS与药物治疗对不同符合条件动脉的症状性ICAS的疗效。主要结局是入组后30天内的卒中或死亡，或30天后至1年内符合条件动脉区域的卒中。采用意向性治疗方法，并使用伴有95%置信区间的风险比（HR）来传达风险估计值。
从颅内狭窄支架置入术与积极药物治疗预防复发性卒中试验和中国症状性颅内严重狭窄血管成形术和支架置入术试验中收集了809例个体的数据。400例被指定接受PTAS，而409例被分配接受单纯药物治疗。对于主要结局，症状性BA狭窄患者接受PTAS的风险显著高于药物治疗（17.17%对7.77%；风险比，2.38（1.03至5.52）；p = 0.
