title: Endovascular vs. medical therapy in symptomatic vertebral artery stenosis: a meta-analysis.
abstract: This meta-analysis aims to compare percutaneous transluminal angioplasty (PTA) to medical treatment (MT) for symptomatic vertebral artery stenosis (SVAS) treatment. We searched PubMed, Springer, Google Scholar, Clinical Trials, Cochrane Central, Chinese National Knowledge Infrastructure, and China Biological Medicine databases. All relevant comparative trials were included. All summary estimates were calculated by random-effect models. Ten comparative trials involving 672 patients were identified. Within 30-day follow-up, there was no significant difference between PTA plus MT and MT alone in vascular death, any stroke, posterior circulation TIA, posterior circulation infarction, and ischemic stroke (all P > 0.05). With a follow-up of more than 1 year, no significant difference was found between PTA plus MT and MT alone in all-cause death (3 vs. 7 %, P = 0.24), vascular death (4 vs. 7 %, P = 0.34), posterior circulation stroke (5 vs. 8 %, P = 0.48), posterior circulation ischemic events (8 vs. 25 %, P = 0.23), posterior circulation TIA (10 vs. 38 %, P = 0.11), posterior circulation infarction (6 vs. 12 %, P = 0.51), vertebral artery occlusion (6 vs. 12 %, P = 0.58), and in secondary long-term events, including any stroke, anterior circulation stroke, hemorrhagic stroke, and myocardial infarction (all P > 0.05), although PTA plus MT could largely reduce the vertebral artery stenosis rate [MD 63.05 %, 95 % CI (32.77-93.34 %), P < 0.01]. Hence, PTA plus MT may be not superior to MT alone for SVAS treatment. Larger randomized trials are needed to verify the optimum therapy for SVAS.
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Feng
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Mei
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Benlei
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Yin
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China. wb001792@whu.edu.cn.
authors.forename: Yumin
authors.initials: Y
authors.lastname: Liu
mesh_terms: D017130:Angioplasty / Q000379:methods*; D003131:Combined Modality Therapy; D016208:Databases, Factual / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D005343:Fibrinolytic Agents
keywords: Angioplasty; Endovascular procedure; Medical treatment; Meta-analysis; Stenting; Vertebral artery stenosis