Stenting for symptomatic intracranial atherosclerotic stenosis:A meta-analysis of randomized trials
10.3760/cma.j.issn.1673-4165.2017.08.004
- VernacularTitle:支架置入术治疗有症状颅内动脉粥样硬化性狭窄:随机对照试验的汇总分析
- Author:
Guosen BU
1
;
Xiaobei WANG
;
Jianhua MA
;
Jian CAI
Author Information
1. 新疆医科大学第一附属医院神经内科
- Keywords:
Intracranial Arteriosclerosis;
Stroke;
Stents;
Platelet Aggregation Inhibitors;
Anticoagulants;
Drug Therapy,Combination;
Randomized Controlled Trial;
Meta-Analysis
- From:
International Journal of Cerebrovascular Diseases
2017;25(8):709-716
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the efficacy and safety of drug therapy alone and stenting for symptomatic intracranial atherosclerotic stenosis (sICAS) in order to provide the best evidence for clinical practice.Methods PubMed,EMbase,Cochrane Library,CBM,CNKI,and Wanfang database were retrieved.The randomized controlled trials (RCTs) on the efficacy and safety of drug therapy and stent-assisted therapy for sICAS were enrolled.The RevMan 5.3 software was used for the meta-analysis.Results A total of 6 RCTs and 782 patients were enrolled.The results of meta-analysis showed that there were no significant differences in stroke or death (odds ratio [OR] 1.61,95％ confidence interval [CI] 0.89-2.91;P=0.12) and fatal stroke within l year (OR 1.60,95％ CI 0.96-2.67,P=0.07) between the stenting group and the drug therapy group.The risks of symptomatic intracerebral hemorrhage (OR 9.51,95％ CI 2.89-31.29;P＜0.01) and any stroke or death (OR 2.15,95％ CI 1.21-3.82;P＜0.01) in the stenting group were higher than those in the drug therapy group.The subgroup analysis showed the risks of any stroke or death within 30 d in the stenting group were significant higher than those in the drug therapy group (OR 2.94.95％ CI 1.55-5.60;P ＜0.01),and there were no sig-nificant differences in anv stroke or death within 1 year (OR 1.90,95％ CI 0.50-7.61;P=0.35) and 2 years (OR 1.38,95％ CI 0.91-2.08;P=0.13);the risks of symptomatic intracerebral hemorrhage within 30 d (OR 10.15,95％ CI 1.92-53.64,P ＜0.01) and within 1 year (OR 8.80,95％ CI 1.60-48.25,P =0.01) in the stenting group were higher than those of the drug therapy group.Conclusions The risks of symptomatic intracerebral hemorrhage and any stroke or death in the stenting group were significantly higher than those in the drug therapy group,therefore,the preferred stenting was not recommended in patients with sICAS.However,stenting still can be considered in patients who failed regular drug therapy and who may benefit greater from stenting.
