Submaximal Angioplasty for Symptomatic Intracranial Atherosclerotic Disease: A Meta-Analysis of Peri-Procedural and Long-Term Risk.
BACKGROUND
Symptomatic intracranial atherosclerotic disease (ICAD) is an important cause of stroke. Although the high periprocedural risk of intracranial stenting from recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option.


OBJECTIVE
To examine the periprocedural and long-term risks associated with submaximal angioplasty for ICAD based on the available literature.


METHODS
All English language studies of intracranial angioplasty for ICAD were screened. Inclusion criteria were as follows: ≥ 5 patients, intervention with submaximal angioplasty alone, and identifiable periprocedural (30-d) outcomes. Analysis was co-nducted to identify the following: 1) periprocedural risk of any stroke (ischemic or hemorrh-agic) or death, and 2) stroke in the territory of the target vessel and fatal stroke beyond 30 d. Mixed effects logistic regression was used to summarize event rates. Funnel plot and rank correlation tests were employed to detect publication bias. The relative risk of periprocedural events from anterior vs posterior circulation disease intervention was also examined.


RESULTS
A total of 9 studies with 408 interventions in 395 patients met inclusion criteria. Six of these studies included 113 posterior circulation interventions. The estimated pooled rate for 30-d stroke or death following submaximal angioplasty was 4.9% (95% CI: 3.2%-7.5%), whereas the estimated pooled rate beyond 30 d was 3.7% (95% CI: 2.2%-6.0%). There was no statistical difference in estimated pooled rate for 30-d stroke or death between patients with anterior (4.8%, 95% CI: 2.8%-7.9%) vs posterior (5.3%, 95% CI: 2.4%-11.3%) circulation disease (P > .99).


CONCLUSION
Submaximal angioplasty represents a potentially promising intervention for symptomatic ICAD.
['Stapleton|Christopher J|CJ|', 'Chen|Yi-Fan|YF|', 'Shallwani|Hussain|H|', 'Vakharia|Kunal|K|', 'Turan|Tanya N|TN|', 'Woo|Henry H|HH|', 'Derdeyn|Colin P|CP|', 'Charbel|Fady T|FT|', 'Siddiqui|Adnan H|AH|', 'Amin-Hanjani|Sepideh|S|']
D000368:Aged D017130:Angioplasty D001699:Biometry D005260:Female D006801:Humans D002537:Intracranial Arteriosclerosis D008297:Male D008875:Middle Aged D011300:Preoperative Care D012189:Retrospective Studies D012307:Risk Factors D015607:Stents D020521:Stroke D013997:Time Factors D016896:Treatment Outcome
Submaximal angioplasty Angioplasty Intracranial atherosclerotic disease Stroke Blood flow Hypoperfusion