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Ischemic Stroke
Review
Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis
  1. Seyed Mohammad Seyedsaadat1,
  2. Yagiz Ugur Yolcu2,
  3. Ain Neuhaus3,
  4. Asim Rizvi1,
  5. Muayad Alzuabi4,
  6. Mohammad H Murad5,
  7. Waleed Brinjikji6,
  8. Mohamad Bydon2,
  9. David F Kallmes7
  1. 1Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  2. 2Department of Neurologic Surgery, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  3. 3Radcliffe Department of Medicine, University of Oxford, Oxford, UK
  4. 4Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
  5. 5Center for Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA
  6. 6Mayo Clinic Minnesota, Rochester, Minnesota, USA
  7. 7Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Yagiz Ugur Yolcu, Department of Neurologic Surgery, Mayo Clinic Minnesota, Rochester, MN 55902, USA; yolcu.yagiz{at}mayo.edu

Abstract

Introduction Management approaches for intracranial atherosclerosis include medical, surgical, or endovascular treatment. Among endovascular treatments, recent studies have stated that submaximal angioplasty (SA) may offer considerable benefits and be a promising alternative to aggressive medical therapyand/or stenting in the treatment of intracranial atherosclerotic disease (ICAD).

Objective To investigate the rates of periprocedural and long-term cerebrovascular accidents, mortality, and restenosis in patients with symptomatic ICAD who were treated with SA.

Methods An electronic database search was performed for relevant studies that reported clinical outcomes of patients with ICAD following SA. Outcomes of interest were incidence of transient ischemic attack, intracerebral hemorrhage, stroke, and mortality in the periprocedural period and at 1 year. The periprocedural period was defined as the time from SA until 30 days after the procedure. Technical success and restenosis rates after the procedure were also analyzed.

Results A total of 19 studies with 777 patients were identified. The technical success rate was 93% (95% CI 85% to 98%). The incidence of 30-day and 1-year stroke (all types) was 3% (95% CI 1% to 5%) and 5% (95% CI 4% to 8%), respectively. Thirty-day and 1-year mortality was found to be 1% (95% CI 0% to 2%) and 2% (95% CI 0% to 4%), respectively. The combined incidence of stroke or death was 5% (95% CI 3% to 8%) at 30 days, and 9% (95% CI 7% to 12%) at 1 year.

Conclusion The findings suggest that SA might be a promising alternative treatment in the treatment of symptomatic ICAD due to its favorable technical profile, periprocedural safety, and long-term efficacy. A randomized clinical trial is warranted to compare the safety and efficacy of SA with 'gold standard' medical treatment.

  • angioplasty, balloon
  • endovascular procedures
  • intracranial arteriosclerosis
  • stroke
  • treatment outcome

https://doi.org/10.1136/neurintsurg-2019-015451

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    Footnotes

    • Twitter @yagizyolcu

    • SMS and YUY contributed equally.

    • Contributors All authors (SMS, YUY, AN, AR, MA, MHM, WB, MB, and DFK) have made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting of the work or revising it critically for important intellectual content. SMS, YUY, and AA made substantial contributions to data collection. All authors have provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SMS made substantial contributions to the conception or design of the work; the acquisition, analysis and interpretation of data for the work; drafting of the work, provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YUY made substantial contributions to the conception or design of the work; the acquisition, analysis and interpretation of data for the work; drafting of the work, provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AN made substantial contributions to the conception or design of the work; the acquisition, analysis and interpretation of data for the work; drafting of the work, provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AR made substantial contributions to the conception or design of the work; provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MA made substantial contributions to the conception or design of the work; provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MHM has made substantial contributions to analysis and interpretation of data for the work; provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WB made substantial contributions to the conception or design of the work; revised the manuscript critically for important intellectual content, provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MB revised the manuscript critically for important intellectual content, has provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DFK made substantial contributions to the conception or design of the work; revised the manuscript critically for important intellectual content, provided final approval of the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data could be made available upon request from the corresponding author.