title: Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The cumulative safety and efficacy measures of percutaneous transluminal angioplasty and stenting (PTAS) for secondary stroke prevention in patients with symptomatic intracranial arterial stenosis (sICAS) have not previously been evaluated using a meta-analytical approach.
  
  
  METHODS
  We conducted a systematic review and random effects meta-analysis of all available randomized controlled trials (RCTs) evaluating the safety and efficacy of PTAS (in comparison with medical therapy) for sICAS.
  
  
  RESULTS
  Three RCTs (678 total patients) were included in the quantitative analysis. PTAS was associated with a higher risk of recurrent ischemic stroke in the territory of qualifying artery both within 30 days [risk ratio (RR) = 2.21, 95% confidence interval (CI) 1.10-4.43] and 1 year (RR = 1.92, 95% CI 1.10-3.36). PTAS was also related to a higher risk of any ischemic stroke within 30 days from the index event (RR = 2.08, 95% CI 1.17-3.71). The risk for intracranial hemorrhage was found to be higher in PTAS patients both within 30 days (RR = 10.60, 95% CI 1.98-56.62) and 1 year (RR = 8.15, 95% CI 1.50-44.34). The composite outcome of any stroke or death within 1 year (RR = 2.29, 95% CI 1.13-4.66) and 2 years (RR = 1.52, 95% CI 1.04-2.21) was higher in PTAS than in medical therapy. PTAS was associated with a higher risk of any stroke or death within 2 years in the sICAS subgroup located in posterior circulation (RR = 2.37, 95% CI 1.27-4.42).
  
  
  CONCLUSIONS
  PTAS is associated with adverse early and long-term outcomes and should not be recommended in patients with sICAS. Further research to identify subgroups of patients who could also serve as candidates for future interventional trials along with efforts to reduce procedure-related complications are needed.
authors: Second Department of Neurology, University of Athens, Iras 39, Gerakas Attikis, Athens, 15344, Greece.
authors: Georgios
authors: G
authors: Tsivgoulis
authors: Second Department of Neurology, 'Attikon'Hospital, School of Medicine, University of Athens, Athens, Greece Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
authors: Aristeidis H
authors: AH
authors: Katsanos
authors: Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
authors: Georgios
authors: G
authors: Magoufis
authors: Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
authors: Odysseas
authors: O
authors: Kargiotis
authors: Second Department of Neurology, 'Attikon' Hospital, School of Medicine, University of Athens, Athens, Greece.
authors: Georgios
authors: G
authors: Papadimitropoulos
authors: Department of Neurology, Democritus University of Thrace, Alexandroupolis, Greece.
authors: Konstantinos
authors: K
authors: Vadikolias
authors: Second Department of Neurology, Aristotelian University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors: Theodoros
authors: T
authors: Karapanayiotides
authors: Department of Neurology, University of Patras, Patras, Greece.
authors: John
authors: J
authors: Ellul
authors: Australian Catholic University, Sydney, Australia.
authors: Anne W
authors: AW
authors: Alexandrov
authors: Department of Neurology, Henry Ford Hospital Detroit, Michigan Department of Neurology, Medical School, University of Crete, Heraklion, Crete, Greece.
authors: Panayiotis D
authors: PD
authors: Mitsias
authors: Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors: Andrei V
authors: AV
authors: Alexandrov
keywords: ischemic stroke; percutaneous transluminal angioplasty; stenting; symptomatic intracranial arterial stenosis