PT  - JOURNAL ARTICLE
AU  - Wu, Qiaowei
AU  - Wang, Jie
AU  - Zheng, Bingjie
AU  - Qi, Jingtao
AU  - Xu, Shancai
AU  - Wu, Pei
AU  - Zhang, Guang
AU  - Ji, Zhiyong
AU  - Wang, Chunlei
AU  - Yao, Jinbiao
AU  - Jiao, Liqun
AU  - Gao, Peng
AU  - Wang, Tao
AU  - Wang, Daming
AU  - Li, Tianxiao
AU  - He, Yingkun
AU  - Zhao, Zhenwei
AU  - Cai, Yiling
AU  - Wu, Wei
AU  - He, Weiwen
AU  - Shi, Huaizhang
AU  - Li, Yuchen
ED  - ,
TI  - Impact of qualifying artery on the efficacy of stenting plus medical therapy versus medical therapy alone in patients with symptomatic intracranial stenosis: a post-hoc analysis of the CASSISS trial
AID  - 10.1136/jnis-2023-020456
DP  - 2024 Jul 01
TA  - Journal of NeuroInterventional Surgery
PG  - 663--669
VI  - 16
IP  - 7
4099  - http://jnis.bmj.com/content/16/7/663.short
4100  - http://jnis.bmj.com/content/16/7/663.full
SO  - J NeuroIntervent Surg2024 Jul 01; 16
AB  - Background A recent trial failed to show any benefit of stenting plus medical therapy over medical therapy alone in patients with symptomatic intracranial stenosis. We aimed to examine whether the symptomatic qualifying artery modifies the effect of stenting plus medical therapy.Methods This is a post-hoc analysis of the CASSISS trial that included patients with symptomatic intracranial stenosis, randomly assigned to undergo stenting plus medical therapy or medical therapy alone; 358/380 patients were included. Multivariable logistic regression analysis was used with an interaction term to estimate the altered treatment effect by the qualifying artery. The primary outcome was a composite of stroke or death within 30 days or stroke in the qualifying artery territory beyond 30 days through 1 year. The five secondary outcomes included stroke or death related to the qualifying artery territory at 2 and 3 years.Results No significant treatment allocation-by-stenosis site interaction was observed (Pinteraction=0.435). Compared with medical therapy alone, the adjusted ORs for stenting plus medical therapy were 2.73 (95% CI 0.42 to 17.65) for internal carotid artery stenosis, 1.20 (95% CI 0.29 to 4.99) for M1 stenosis, 0.23 (95% CI 0.02 to 2.31) for vertebral artery stenosis, and 1.33 (95% CI 0.34 to 5.28) for basilar artery stenosis. Of the five secondary outcomes, none showed a significant treatment allocation-by-stenosis site interaction including stroke in the qualifying artery territory at 2 years (Pinteraction=0.659) and 3 years (Pinteraction=0.493).Conclusions Among patients with transient ischemic attacks or ischemic stroke due to severe intracranial atherosclerotic stenosis, there was no evidence that the symptomatic qualifying artery could determine the addition of stenting to medical therapy.Data are available upon reasonable request. Requests to access an anonymized dataset supporting the conclusions may be obtained following review.