Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses

Systematic review and meta-analysis

Ahmad R. Abuzinadah, Mohammed H. Alanazy, Mohammed A. Almekhlafi, Yanjune Duan, Haifeng Zhu, Mikael Mazighi, Helmi Lutsep, Tyrone Donnon, Michael D. Hill

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study. Methods We conducted a systematic review and metaanalysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates. Results 23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95% CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95% CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95% CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95% CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 personyears (95% CI 5.5 to 9.0) in the endovascular group. Conclusions Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

Original languageEnglish (US)
Pages (from-to)112-116
Number of pages5
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number2
DOIs
StatePublished - Feb 1 2016

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Meta-Analysis
Pathologic Constriction
Stroke
Recurrence
Therapeutics
Basilar Artery
Vertebral Artery
Bibliography
Group Psychotherapy
MEDLINE
Language
Arteries
Incidence

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses : Systematic review and meta-analysis. / Abuzinadah, Ahmad R.; Alanazy, Mohammed H.; Almekhlafi, Mohammed A.; Duan, Yanjune; Zhu, Haifeng; Mazighi, Mikael; Lutsep, Helmi; Donnon, Tyrone; Hill, Michael D.

In: Journal of NeuroInterventional Surgery, Vol. 8, No. 2, 01.02.2016, p. 112-116.

Research output: Contribution to journalArticle

Abuzinadah, Ahmad R. ; Alanazy, Mohammed H. ; Almekhlafi, Mohammed A. ; Duan, Yanjune ; Zhu, Haifeng ; Mazighi, Mikael ; Lutsep, Helmi ; Donnon, Tyrone ; Hill, Michael D. / Stroke recurrence rates among patients with symptomatic intracranial vertebrobasilar stenoses : Systematic review and meta-analysis. In: Journal of NeuroInterventional Surgery. 2016 ; Vol. 8, No. 2. pp. 112-116.
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abstract = "Background A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study. Methods We conducted a systematic review and metaanalysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates. Results 23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95{\%} CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95{\%} CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95{\%} CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95{\%} CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 personyears (95{\%} CI 5.5 to 9.0) in the endovascular group. Conclusions Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.",
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T2 - Systematic review and meta-analysis

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AU - Alanazy, Mohammed H.

AU - Almekhlafi, Mohammed A.

AU - Duan, Yanjune

AU - Zhu, Haifeng

AU - Mazighi, Mikael

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AU - Donnon, Tyrone

AU - Hill, Michael D.

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N2 - Background A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study. Methods We conducted a systematic review and metaanalysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates. Results 23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95% CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95% CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95% CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95% CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 personyears (95% CI 5.5 to 9.0) in the endovascular group. Conclusions Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

AB - Background A recent randomized trial of patients with primarily anterior circulation intracranial artery stenosis showed that intensive medical therapy was superior to intracranial stenting in preventing recurrent stroke. The rate of stroke recurrence or death in symptomatic intracranial vertebrobasilar stenosis with medical therapy alone may be especially high, and rates compared with endovascular therapy need further study. Methods We conducted a systematic review and metaanalysis of studies reporting the rates of stroke recurrence or death (the primary outcome) in symptomatic intracranial vertebrobasilar stenosis with medical or endovascular treatment over a minimum follow-up period of 6 months. We included all studies in any language indexed in MEDLINE or EMBASE, supplemented by bibliography searches and by contacting the authors. The secondary endpoints were stroke recurrence, and basilar artery and vertebral artery stroke recurrence rates. Results 23 studies (592 medical treatment patients and 480 endovascular treatment patients) were included. The risk of combined stroke recurrence or death was 14.8 per 100 person-years (95% CI 9.5 to 20.1) in the medical group compared with 8.9 per 100 person-years (95% CI 6.9 to 11.0) in the endovascular group. The incidence rate ratio was 1.3 (95% CI 1.0 to 1.7). The stroke recurrence rate was 9.6 per 100 person-years (95% CI 5.1 to 14.1) in the medical group compared with 7.2 per 100 personyears (95% CI 5.5 to 9.0) in the endovascular group. Conclusions Our results showed that the risk of stroke recurrence or death or the risk of stroke recurrence alone was comparable between the medical and endovascular therapy groups. A small preventive effect of endovascular therapy may exist, particularly if the 30 day postprocedural risk is reduced.

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