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Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis

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Abstract

Intracranial artery atherosclerotic stenosis (ICAS) is one of the most common causes of stroke. Endovascular therapy including balloon angioplasty alone (BA), balloon-mounted stent (BMS), or self-expanding stent (SES) was an important alternative to treat symptomatic ICAS refractory to medical treatment, while none of the three subtypes has been established to be the primary option. We conducted a systematic review and network meta-analysis to determine both the safety and efficacy and establish a hierarchy of different endovascular therapies on symptomatic ICAS. Major databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for studies comparing outcomes of three different endovascular approaches and other comparable non-endovascular therapies for symptomatic ICAS patients published from 1 January 2000 to 1 November 2021. Primary outcomes included short-term mortality or stroke rate (peri-procedural, or mean follow-up ≤ 3 months), and long-term mortality or stroke rate (mean follow-up ≥ 6 months). Pairwise and network meta-analyses based on the above systematic review were conducted. A total of 19 eligible studies involving 3386 patients treated with 4 different approaches (BA, SES, BMS, and medical treatment) were analyzed. For primary outcome, BA had the highest ranking (SUCRA value 78), followed by BMS (SUCRA value 21.5) and SES (SUCRA value 13.1). The short-term mortality or stroke rate was significantly lower in the BA group compared to SES (OR = 2.50; 95% CI 1.12 to 5.57; p = 0.026) or BMS (OR = 0.43; 95% CI 0.19 to 0.96; p = 0.038). Other primary and secondary outcomes were no different among all three types of endovascular therapy. Overall, the studies were of good methodological quality and the consistency was acceptable across all network meta-analyses. BA offers the highest level of safety outcomes in terms of short-term mortality or stroke in treating symptomatic patients with intracranial artery stenosis, compared to SES and BMS, which needs to be confirmed in future studies. Trial registration in PROSPERO database: CRD42018084055.

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Funding

This study was supported by the Beijing Scientific and Technologic Project (Z201100005520019). The funders have no role in the study design, data analysis, and writing of the manuscript.

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Author notes

  1. Tao Wang, Kun Yang, and Xiao Zhang contributed equally and are co-first authors

Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Ave, Xicheng District, Beijing, China

    Tao Wang, Xiao Zhang, Jichang Luo, Ran Xu, Xuesong Bai, Yan Ma & Liqun Jiao

  2. China International Neuroscience Institute (China-INI), Beijing, 100053, China

    Tao Wang, Xiao Zhang, Jichang Luo, Ran Xu, Xuesong Bai, Yan Ma & Liqun Jiao

  3. Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China

    Kun Yang

  4. Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China

    Kun Yang & Yuxiang Yan

  5. Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China

    Xue Wang

  6. National Heart & Lung Institute, Imperial College London, London, UK

    Yutong Yang

  7. Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100053, China

    Yuxiang Yan

  8. Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China

    Liqun Jiao

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  1. Tao Wang
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Contributions

Study concept and design: LJ, YY, and YM. Data collection and supervision: TW, KY, and XZ. Analysis and interpretation of data: KY, TW, YM, YY, and LJ. Drafting of the manuscript: TW, KY, XZ, JL, RX, XW, YY, XB, and LJ. Critical revision of the manuscript for important intellectual content: TW, YY, YM, and LJ. Obtained funding: YM. TW, KY, and XZ contributed equally and are co-first authors. All authors approved the final version of the manuscript before submission.

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Correspondence to Yan Ma, Yuxiang Yan or Liqun Jiao.

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Wang, T., Yang, K., Zhang, X. et al. Endovascular Therapy for Symptomatic Intracranial Artery Stenosis: a Systematic Review and Network Meta-analysis. Transl. Stroke Res. 13, 676–685 (2022). https://doi.org/10.1007/s12975-022-00996-8

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