title: Comparison between primary angioplasty and stent placement for symptomatic intracranial atherosclerotic disease: meta-analysis of case series.
abstract: OBJECTIVE
  To compare the short- and long-term rates of stroke-and/or-death associated with primary angioplasty alone and angioplasty with stent placement using a meta-analysis of published studies. Both primary angioplasty alone and angioplasty with stent placement have been proposed as treatment strategies for symptomatic intracranial atherosclerotic disease to reduce the risk of stroke-and/or-death with best medical treatment alone. However, it remains unclear which of these endovascular techniques offers the best risk reduction.
  
  
  METHODS
  We identified pertinent studies published between January 1980 and May 2008 using a search on PubMed and Cochrane libraries, supplemented by a review of bibliographies of selected publications. The incidences of stroke-and/or-death were estimated for each report and pooled for both angioplasty alone and angioplasty with stent placement at 1 month and 1 year postintervention and then compared using a random-effects model. The association of year of publication and 1-year incidence of stroke-and/or-death was analyzed with meta-regression.
  
  
  RESULTS
  After applying our selection criteria, we included 69 studies (33 primary angioplasty-alone studies [1027 patients] and 36 studies of angioplasty with stent placement [1291 patients]) in the analysis. There were a total of 91 stroke-and/or-deaths reported in the angioplasty-alone-treated group (8.9%; 95% confidence interval [CI], 7.1%-10.6%), compared with 104 stroke-and/or-deaths in the angioplasty-with-stent-treated group (8.1%; 95% CI, 6.6%-9.5%) during a 1-month period (relative risk [RR], 1.1; P = 0.48). The pooled incidence of 1-year stroke-and/or-death in patients treated with angioplasty alone was 19.7% (95% CI, 16.6%-23.5%), compared with 14.2% (95% CI, 11.9%-16.9%) in the angioplasty-with-stent-treated patients (RR, 1.39; P = 0.009). The incidence of technical success was 79.8% (95% CI, 74.7%-84.8%) in the angioplasty-alone group and 95% (95% CI, 93.4%-96.6%) in the angioplasty-with-stent-treated group (RR, 0.84; P < 0.0001). The pooled restenosis rate was 14.2% (95% CI, 11.8-16.6%) in the angioplasty-alone group, as compared with 11.1% (95% CI, 9.2%-13.0%) in the angioplasty-with-stent-treated group (RR, 1.28; P = 0.04). There was no effect of the publication year of the studies on the risk of stroke-and/or-death.
  
  
  CONCLUSIONS
  Risk of 1-year stroke-and/or-death and rate of angiographic restenosis may be lower in symptomatic intracranial atherosclerosis patients treated by angioplasty with stent placement compared with patients treated by angioplasty alone.
authors.affiliation: Department of Neurosurgery and Neurology, Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA. farhan_siddiq@hotmail.com
authors.forename: Farhan
authors.initials: F
authors.lastname: Siddiq
authors.forename: Muhammad Zeeshan
authors.initials: MZ
authors.lastname: Memon
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vazquez
authors.forename: Adnan
authors.initials: A
authors.lastname: Safdar
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome