Abstract Details

Title Outcomes with Endovascular Therapies vs. Medical Treatment for the Treatment of Intracranial Artery Stenosis: A Meta-analysis and Time-to-event Analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-003

Objective To evaluate the short-term and long-term outcomes of EVT compared to MT in intracranial atherosclerosis.

Background There is still controversy about the use of endovascular therapy (EVT) for symptomatic intracranial stenosis (ICAS). Prior studies on percutaneous transluminal angioplasty and stenting have demonstrated either harm or no benefit compared to best medical treatment (MT).

Design/Methods We systematically searched four databases: PubMed, Embase, Scopus, and Web of Science (WOS), from inception to April 5, 2025, without applying any automated filters or language restrictions. Randomized controlled trials (RCTs) comparing EVT versus BMT for patients with symptomatic ICAS of 50% or greater were eligible for inclusion in the analysis. Effect estimates were conducted using a random-effects model.

Results A total of 10 RCTs comprising 1847 patients, 923 in the EVT group and 924 in the MT group. EVT was associated with higher risk of any stroke or all-cause death (OR: 2.69, 95% CI: [1.71 to 4.21], p<0.0001, I²=0%), any ischemic stroke [OR: 2.11, 95% CI: [1.24 to 3.59], p=0.005, I²=0%], intracranial haemorrhage [OR: 3.69, 95% CI: [1.36 to 10.03], p=0.01, I²=13.0%], and all-cause mortality [OR: 3.54, 95% CI: [1.12 to 11.19], p=0.03, I²=0.0%], however the risk of acute ischemic stroke in the qualifying artery territory was similar between the two groups [OR: 0.88, 95% CI: [0.35 to 2.22], p = 0.78, I²=71.0%] within 30 days. Across the first year, the incidence of intracranial haemorrhage was higher in the EVT vs. MT (OR: 4.76, 95% CI: [1.41 to 16.01], p=0.01, I²=0.0%), however, the rest of outcomes were similar between the two groups.

Conclusions Our analysis showed that EVT increased the risk of early adverse effects, without increasing the long-term stroke or mortality events compared to MT. Further studies are needed to underscore the long-term effects.

Authors/Disclosures
Mohamed S. Saad, MD PRESENTER	Dr. Saad has nothing to disclose.
Basma Kamel	Basma Kamel has nothing to disclose.
Omnia Samy El-Sayed, MD	Dr. Samy El-Sayed has nothing to disclose.
Alaa Abdrabou Abouelmagd, MD	Dr. Abouelmagd has nothing to disclose.
Mena A. Elgendy, MD	Dr. Elgendy has nothing to disclose.
Elsayed S. Moubarak, MBBS	Dr. Moubarak has nothing to disclose.
Mohammed O. Abdelmawla, MBBS	Dr. Abdelmawla has nothing to disclose.
Omar Abdelkader, MD (Westchester Medical Center)	Dr. Abdelkader has nothing to disclose.
Sai Krishna Vallamchetla, MBBS (Mayo Clinic, Florida)	Mr. Vallamchetla has nothing to disclose.
Marym T. Abdelhamid II, MBBS	Dr. Abdelhamid has nothing to disclose.

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