Submaximal angioplasty in the treatment of patients with symptomatic ICAD: A systematic review and meta-analysis

Seyed Mohammad Seyedsaadat, Yagiz Ugur Yolcu, Ain Neuhaus, Asim Rizvi, Muayad Alzuabi, Mohammad H. Murad, Waleed Brinjikji, Mohamad Bydon, David F. Kallmes

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Angioplasty
Meta-Analysis
Stroke
Mortality
Incidence
Therapeutics
Intracranial Arteriosclerosis
Safety
Transient Ischemic Attack
Cerebral Hemorrhage
Randomized Controlled Trials
Databases

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Submaximal angioplasty in the treatment of patients with symptomatic ICAD : A systematic review and meta-analysis. / Seyedsaadat, Seyed Mohammad; Yolcu, Yagiz Ugur; Neuhaus, Ain; Rizvi, Asim; Alzuabi, Muayad; Murad, Mohammad H.; Brinjikji, Waleed; Bydon, Mohamad; Kallmes, David F.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalReview article

Seyedsaadat, Seyed Mohammad ; Yolcu, Yagiz Ugur ; Neuhaus, Ain ; Rizvi, Asim ; Alzuabi, Muayad ; Murad, Mohammad H. ; Brinjikji, Waleed ; Bydon, Mohamad ; Kallmes, David F. / Submaximal angioplasty in the treatment of patients with symptomatic ICAD : A systematic review and meta-analysis. In: Journal of neurointerventional surgery. 2019.
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T1 - Submaximal angioplasty in the treatment of patients with symptomatic ICAD

T2 - A systematic review and meta-analysis

AU - Seyedsaadat, Seyed Mohammad

AU - Yolcu, Yagiz Ugur

AU - Neuhaus, Ain

AU - Rizvi, Asim

AU - Alzuabi, Muayad

AU - Murad, Mohammad H.

AU - Brinjikji, Waleed

AU - Bydon, Mohamad

AU - Kallmes, David F.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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KW - endovascular procedures

KW - intracranial arteriosclerosis

KW - stroke

KW - treatment outcome

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