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Endovascular vs. medical therapy in symptomatic vertebral artery stenosis: a meta-analysis

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Abstract

This meta-analysis aims to compare percutaneous transluminal angioplasty (PTA) to medical treatment (MT) for symptomatic vertebral artery stenosis (SVAS) treatment. We searched PubMed, Springer, Google Scholar, Clinical Trials, Cochrane Central, Chinese National Knowledge Infrastructure, and China Biological Medicine databases. All relevant comparative trials were included. All summary estimates were calculated by random-effect models. Ten comparative trials involving 672 patients were identified. Within 30-day follow-up, there was no significant difference between PTA plus MT and MT alone in vascular death, any stroke, posterior circulation TIA, posterior circulation infarction, and ischemic stroke (all P > 0.05). With a follow-up of more than 1 year, no significant difference was found between PTA plus MT and MT alone in all-cause death (3 vs. 7 %, P = 0.24), vascular death (4 vs. 7 %, P = 0.34), posterior circulation stroke (5 vs. 8 %, P = 0.48), posterior circulation ischemic events (8 vs. 25 %, P = 0.23), posterior circulation TIA (10 vs. 38 %, P = 0.11), posterior circulation infarction (6 vs. 12 %, P = 0.51), vertebral artery occlusion (6 vs. 12 %, P = 0.58), and in secondary long-term events, including any stroke, anterior circulation stroke, hemorrhagic stroke, and myocardial infarction (all P > 0.05), although PTA plus MT could largely reduce the vertebral artery stenosis rate [MD 63.05 %, 95 % CI (32.77–93.34 %), P < 0.01]. Hence, PTA plus MT may be not superior to MT alone for SVAS treatment. Larger randomized trials are needed to verify the optimum therapy for SVAS.

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Acknowledgments

This study was funded by the National Natural Science Foundation of China (81371273).

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Authors and Affiliations

  1. Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China

    Hongliang Feng, Yi Xie, Bin Mei, Yang Liu, Tao Wang & Yumin Liu

  2. Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China

    Benlei Li

  3. Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China

    Changqing Yin

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  1. Hongliang Feng
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  2. Yi Xie
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  7. Tao Wang
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Correspondence to Yumin Liu.

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Supplementary Figure 1S: Risk of each bias item presented as percentages across all included RCT trials (EPS 301 kb)

415_2016_8267_MOESM2_ESM.eps

Supplementary Figure 2S: Forest plots of secondary long-term outcomes of PTA plus MT compared with MT alone for SVAS treatment (EPS 1157 kb)

415_2016_8267_MOESM3_ESM.docx

Supplementary Table 1S: Sensitivity analysis by excluding six trials with less than 3-year follow-up and Begg’s test for publication bias (DOCX 20 kb)

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Feng, H., Xie, Y., Mei, B. et al. Endovascular vs. medical therapy in symptomatic vertebral artery stenosis: a meta-analysis. J Neurol 264, 829–838 (2017). https://doi.org/10.1007/s00415-016-8267-0

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  • DOI: https://doi.org/10.1007/s00415-016-8267-0

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