PT  - JOURNAL ARTICLE
AU  - Li, Tianhua
AU  - Luo, Jichang
AU  - Bai, Xuesong
AU  - Almallouhi, Eyad
AU  - Gao, Peng
AU  - Liu, Delin
AU  - Xu, Ran
AU  - Xu, Wenlong
AU  - Lu, Guangdong
AU  - Gong, Haozhi
AU  - Zhang, Xiao
AU  - Lu, Taoyuan
AU  - Wang, Jie
AU  - Yang, Renjie
AU  - Xing, Zixuan
AU  - Liu, Guangjie
AU  - Dai, Yufu
AU  - Derdeyn, Colin P
AU  - Jiao, Liqun
AU  - Wang, Tao
TI  - Stenting for symptomatic intracranial arterial stenosis with different qualifying arteries: a preplanned pooled individual patient data analysis
AID  - 10.1136/svn-2024-003532
DP  - 2024 Oct 24
TA  - Stroke and Vascular Neurology
PG  - svn-2024-003532
4099  - http://svn.bmj.com/content/early/2024/10/24/svn-2024-003532.short
4100  - http://svn.bmj.com/content/early/2024/10/24/svn-2024-003532.full
AB  - Background The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) relative to medical management in treating symptomatic intracranial arterial stenosis (ICAS) varies based on the qualifying artery. This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery (ICA), middle cerebral artery (MCA), vertebral artery (VA) and basilar artery (BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials, evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries. The primary outcome was stroke or death within 30 days postenrolment, or stroke in the region of the qualifying artery beyond 30 days through 1 year. A methodology based on intention-to-treat was employed, and HR accompanied by 95% CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial. Four hundred were designated for PTAS, while 409 were assigned to medical therapy alone. For the primary outcome, patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy (17.17% vs 7.77%; 9.40; HR, 2.38 (1.03 to 5.52); p=0.04). However, PTAS had no significant difference in patients with symptomatic ICA (26.67% vs 16.67%; HR, 1.68 (0.78 to 3.62); p=0.19), MCA (8.28% vs 9.79%; HR, 0.85 (0.42 to 1.74); p=0.66) and VA stenosis (9.52% vs 10.71%; HR, 0.91 (0.32 to 2.62); p=0.86) compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis. Without significant technological advancements to mitigate these risks, PTAS offers limited benefits. For symptomatic ICA, MCA and VA stenosis, PTAS provided no significant advantage.Data are available upon reasonable request.