Effect of percutaneous transluminal angioplasty and stenting vs aggressive medical management on Risk of Stroke and Death in Patients with stroke or intracranial atherosclerotic stenosis: a systematic review and meta-analysis

Background: There are currently two treatment strategies mainly for high-risk patients: percutaneous transluminal angioplasty and stenting (PTAS) and aggressive medical management (AMM). However, the choice between PTAS or AMM remains controversial for patients with stroke or intracranial atherosclerotic stenosis (ICAS). Methods: : The investigators searched PubMed, Web of Science, Embase, Scopus, and Cochrane library databases. Randomized controlled trial (RCT) comparing the PTAS and AMM for patients with stroke or ICAS were selected. RevMan 5.3 was used to analyze the results and risk of bias. The primary endpoints are stroke and death within 30 days after enrollment, or ischemic stroke in the territory of the qualifying artery beyond 30 days, and entire follow-up endpoints. The secondary outcomes were the disabling or fatal stroke, and incidence of death within 3 years. Results: : Four studies, 989 patients were included in this article. The AMM group was superior in the entire follow-up endpoint (OR: 0.56; 95% CI: 0.40, 0.79). The AMM also better in primary endpoint within 30 days (OR: 0.32; 95% CI: 0.17, 0.61). There was no significant difference beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86). The remaining outcomes, such as stroke and death, were not significantly different (P>0.05). Conclusion: This meta-analysis shows AMM is significantly more effective than PTAS in subjects with ICAS because of the high rate of periprocedural OR: 0.32; 95% CI: 0.17, 0.61) and entire follow-up (OR: 0.56; 95% CI: 0.40, 0.79) stroke from PTAS and the fact that PTAS offers no benefit over AMM beyond 30 days (OR: 1.08; 95% CI: 0.63, 1.86).