1225. Submaximal Angioplasty for Symptomatic Intracranial Atherosclerotic Disease: a Meta-analysis of Peri-procedural and Long-term Risk

Authors: Christopher James Stapleton, MD; Yi-Fan Chen; Hussain Shallwani; Tanya Turan; Henry Woo; Colin Derdeyn; Fady Charbel, MD; Adnan Siddiqui, MD, PhD; Sepideh Amin-Hanjani, MD (Chicago, IL)

Introduction:

Symptomatic intracranial atherosclerotic disease (ICAD) is an important cause of stroke. While the high peri-procedural risk of intracranial stenting in recent randomized studies has dampened enthusiasm for such interventions, submaximal angioplasty without stenting may represent a safer endovascular treatment option. We sought to examine the peri-procedural and long-term risks associated with submaximal angioplasty for ICAD based on the available literature.

Methods:

All English language studies of intracranial angioplasty for ICAD were screened. Inclusion criteria were as follows: ≥5 patients; intervention with submaximal angioplasty alone; and identifiable peri-procedural (30-day) outcomes. Analysis was conducted to identify 1) peri-procedural risk of any stroke (ischemic or hemorrhagic) or death and 2) stroke in the territory of the target vessel or fatal stroke beyond 30 days. Peri-procedural risk of anterior versus posterior circulation intervention was also examined. Q and I2 statistics were used to test heterogeneity and random-effect models using the DerSimonian-Laird estimator were used to summarize effect sizes. p<0.05 was considered statistically significant.  

Results:

Nine studies with 408 patients met inclusion criteria. Six of these studies included 113 patients with posterior circulation disease. For each analysis, the non-significant Q test indicated homogeneity across studies and I2=0 suggested none of the total variability was attributable to heterogeneity. The 30-day stroke or death rate following submaximal angioplasty was 4.5% (95% CI: 2.5%-6.4%), while the event rate beyond 30 days was 2.6% (95% CI, 1.1%-4.0%). There was no statistical difference in 30-day stroke or death rates between patients with anterior (3.9%, 95% CI: 2.0%-5.8%) versus posterior (5.0%, 95% CI: 2.2%-7.8%) circulation disease (p>0.99).

Conclusion:

Submaximal angioplasty represents a potentially promising intervention for symptomatic ICAD. These results support the need to examine prospectively the safety and feasibility of this intervention in selected high-risk patients.