Abstract Details

Title Angioplasty and Stenting vs Aggressive Medical Management in Intracranial Atherosclerotic Stenosis: Updated Meta-Analysis of RCTs

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-003

Objective

Our objective was to conduct an updated meta-analysis of RCTs examining stenting and angioplasty with aggressive medical management compared to aggressive medical management alone in patients with ICAS.

Background Previous randomized clinical trials (RCTs) did not establish the superiority of stenting and angioplasty over aggressive medical management for patients with symptomatic intracranial atherosclerotic stenosis (ICAS). However, a recent Chinese RCT (BASIS) has suggested potential benefits of angioplasty

Design/Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched PubMed, Medline, and Cochrane databases for RCTs. The Primary outcome was composite rates of stroke or death within 30-days. Surrogate outcome included composite rates of stroke or death at 1-year. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model.

Results Five RCTs, comprising a total of 1,491 patients with ICAS, were included in this meta-analysis. The stent and angioplasty arm included 743 patients (49.8%), while 748 patients (50.2%) received aggressive medical management alone. Within 30 days, the rates of stroke or death were higher in the stent and angioplasty arm (OR 2.48 [95% CI 1.54-4.00]; p<0.01; I²=0%). No significant difference between the groups was observed when evaluating rates of stroke or death at 1 year (OR 1.20 [95% CI 0.58-2.46]; p=0.63; I²=75%). Subgroup analysis based on the main intervention performed (stent with angioplasty vs. angioplasty alone) indicated the superiority of aggressive medical management in rates of stroke or death within 30 days over both approaches. However, angioplasty alone exhibited lower composite rates at 1 year compared to aggressive medical management (OR 0.33 [95% CI 0.14-0.75]; p=0.008

Conclusions

This meta-analysis does not support stenting and angioplasty as a standard treatment for the wider symptomatic ICAS patient group. There is a need for further RCTs with safer devices and larger cohorts.

Authors/Disclosures
Abdulaziz A. Boqaeid, MBBS (King Abdulaziz Medical City) PRESENTER	Dr. Boqaeid has nothing to disclose.
Mohammed Alqahtani	Mohammed Alqahtani has nothing to disclose.
Muna Alnamlah, MBBS (KFSH&RC)	Dr. Alnamlah has nothing to disclose.
Shatha S. Alqurashi	Ms. Alqurashi has nothing to disclose.
MUHNNAD ASIRI (Neuroscience center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.)	No disclosure on file
Ahmed Alkhiri	Mr. Alkhiri has nothing to disclose.
Fawaz F. Alotaibi, MBBS (King Faisal Specialist Hospital and Research Center)	Dr. Alotaibi has nothing to disclose.
Adel Alhazzani, MD, FRCPC, FAAN (King Saud University)	Dr. Alhazzani has nothing to disclose.
Fahad S. Al-Ajlan, MD	Dr. Al-Ajlan has nothing to disclose.

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