Abstract W P105: Comparison of Intracranial Stent Placement and Best Medical Treatment Alone for Treatment of Symptomatic Intracranial Stenosis
Objective: To compare the short and long term rates of transient ischemic attack (TIA)/ ischemic stroke and mortality between intracranial stent placement and medical therapy alone for treatment of symptomatic intracranial arterial stenosis.
Methods: We identified all prospective and retrospective studies comparing intracranial stent placement and medical management using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. The incidences of adverse effects, namely TIA/stroke and/or death at 30 days post treatment and TIA/stroke, myocardial infarction and/or death at 1 year post treatment were ascertained from all studies. For the meta-analysis, Forest plots and calculation of odds ratios [OR] with 95% confidence intervals [CI] using both fixed and random models were performed. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio.
Results: Three prospective studies including two randomized clinical trials and one retrospective study were identified and included in the meta-analysis. There were a total of 46/347 (13.2%) stroke-and/or-deaths reported in the stent treatment group compared with 16/351 (4.5%) TIA/stroke-and/or-deaths in the medical therapy alone group at 30 days (OR, 2.97; P<0.001; CI 1.64-5.39). The pooled incidence of 1-year TIA/stroke-and/or-deaths in patients with stenting was 51/347 (14.7%), compared with 45/351 (12.8%) in the patients managed with medical therapy alone (OR 1.093; P = 0.815; CI 0.51-2.30). There was no publication bias.
Conclusions: Despite the higher risk of 1 month TIA/stroke-and/or-deaths, patients undergoing intracranial stent placement have similar rates of TIA/stroke-and/or-deaths at 1 year compared with medical treatment alone.
Author Disclosures: V. Jadhav: None. M. Qureshi: None. N. Mian: None. A.I. Qureshi: None.
- © 2014 by American Heart Association, Inc.