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Medical and Endovascular Treatments for Intracranial Atherosclerotic Stenosis: A Network Meta-Analysis

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Abstract

Medical treatment and endovascular therapy are widely used for intracranial atherosclerotic stenosis, but the best treatment strategy remains uncertain. The goal of this study was to compare the safety and effectiveness of medical treatment, stenting, and primary balloon angioplasty (PBA). We searched PubMed, MEDLINE, and EMBASE for trials comparing these three treatments for intracranial stenosis up to December 24, 2020. We performed a network meta-analysis with random-effects models. The primary outcome was any stroke or death during a long-term follow-up. Secondary outcomes included ischemic stroke, intracranial hemorrhage, and death. This network meta-analysis included 14 trials with 1520 participants. No significant difference was found between the three groups in the primary outcome, while PBA was probably the best treatment according to the ranking plot. Medical treatment had significantly lower rate of any stroke or death (odds ratio (OR), 0.31; 95% CI, 0.17–0.56), ischemic stroke (OR, 0.43; 95% CI, 0.23–0.81), and intracranial hemorrhage (OR, 0.12; 95% CI, 0.02–0.71) within 30 days than stenting but did not differ from PBA. The ranking plot demonstrated that PBA was also most likely to rank the highest for ischemic stroke during the long-term follow-up and beyond 30 days, although no significant difference was identified. Medical treatment had lower risk of any stroke or death within 30 days than stenting but did not differ from PBA. All the treatments had similar effects on the prevention of long-term stroke, while PBA had the highest probability of being the most effective.

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Data are available in supplementary material.

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Author information

Author notes

  1. Guangge Peng and Kangyue Li contributed equally to this work

Authors and Affiliations

  1. Department of Neurology, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 101149, China

    Guangge Peng

  2. Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Kangyue Li, Zhongqi Qi, Shuo Li, Xu Tong, Yiming Deng, Xuan Sun & Zhongrong Miao

  3. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China

    Kangyue Li, Anxin Wang, Xue Tian, Zhongqi Qi, Shuo Li, Xu Tong, Yiming Deng, Xuan Sun & Zhongrong Miao

Authors
  1. Guangge Peng
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Contributions

Zhongrong Miao, Xuan Sun, Guangge Peng, and Anxin Wang contributed to the study conception and design. Data collection was performed by Guangge Peng, Kangyue Li, Zhongqi Qi, and Shuo Li. Data analysis was performed by Anxin Wang, Xue Tian, Guangge Peng, and Kangyue Li. The original draft of the manuscript was written by Guangge Peng and Kangyue Li. All authors reviewed and revised the manuscript and approved the final version of the manuscript.

Corresponding authors

Correspondence to Xuan Sun or Zhongrong Miao.

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Prospero registration: CRD42021262994

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Peng, G., Li, K., Wang, A. et al. Medical and Endovascular Treatments for Intracranial Atherosclerotic Stenosis: A Network Meta-Analysis. Transl. Stroke Res. 14, 83–93 (2023). https://doi.org/10.1007/s12975-021-00957-7

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  • DOI: https://doi.org/10.1007/s12975-021-00957-7

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