RT Journal Article
SR Electronic
T1 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
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 663
OP 669
DO 10.1136/jnis-2023-020456
VO 16
IS 7
A1 Wu, Qiaowei
A1 Wang, Jie
A1 Zheng, Bingjie
A1 Qi, Jingtao
A1 Xu, Shancai
A1 Wu, Pei
A1 Zhang, Guang
A1 Ji, Zhiyong
A1 Wang, Chunlei
A1 Yao, Jinbiao
A1 Jiao, Liqun
A1 Gao, Peng
A1 Wang, Tao
A1 Wang, Daming
A1 Li, Tianxiao
A1 He, Yingkun
A1 Zhao, Zhenwei
A1 Cai, Yiling
A1 Wu, Wei
A1 He, Weiwen
A1 Shi, Huaizhang
A1 Li, Yuchen
A1 
YR 2024
UL http://jnis.bmj.com/content/16/7/663.abstract
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.