Angioplasty and/or stenting after thrombectomy in patients with large vessel occlusion associated with underlying intracranial atherosclerotic stenosis: a meta-analysis and systematic review - Report - MDSpire
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Angioplasty and/or stenting after thrombectomy in patients with large vessel occlusion associated with underlying intracranial atherosclerotic stenosis: a meta-analysis and systematic review
Meta-Analysis of Angioplasty and Stenting After Thrombectomy in ICAS-LVO Stroke
Overview
This systematic review and meta-analysis evaluated the efficacy and safety of mechanical thrombectomy combined with angioplasty and/or stenting (MT + angioplasty/stent) versus mechanical thrombectomy (MT) alone in patients with large vessel occlusion due to intracranial atherosclerotic stenosis (ICAS-LVO). The analysis included both randomized controlled trials and observational studies, focusing on vessel recanalization, functional independence, and safety outcomes.
Background
Ischemic stroke is a major cause of morbidity and mortality worldwide, with large vessel occlusion (LVO) accounting for approximately 20% of ischemic strokes and associated with worse outcomes. Intracranial atherosclerotic stenosis (ICAS) is a significant cause of LVO, with variable prevalence depending on population characteristics. Mechanical thrombectomy (MT) is the standard treatment for ICAS-LVO, but the presence of ICAS increases the risk of reocclusion and recurrent stroke. Given these challenges, adjunctive angioplasty and/or stenting following MT has been explored to improve vessel patency and clinical outcomes.
Data Highlights
Outcome
MT + Angioplasty/Stent
MT Alone
Risk Ratio (95% CI)
Vessel Recanalization
Higher rates reported
Lower rates reported
Significant improvement with MT + angioplasty/stent
Functional Independence (mRS 0–2 at 90 days)
Improved functional outcomes
Lower functional independence
Favorable for MT + angioplasty/stent
Symptomatic Intracranial Hemorrhage
No significant increase
Comparable rates
No significant difference
Mortality at 90 days
Similar or reduced mortality
Comparable mortality
No significant difference
Key Findings
MT combined with angioplasty and/or stenting significantly improves vessel recanalization rates compared to MT alone in ICAS-LVO patients.
Functional independence at 90 days (mRS 0–2) is higher in patients treated with MT + angioplasty/stent.
No significant increase in symptomatic intracranial hemorrhage was observed with adjunctive angioplasty/stenting.
Mortality rates at 90 days did not differ significantly between treatment groups.
Subgroup analyses suggest benefits are consistent in patients with stenosis >70%.
Clinical Implications
For patients with ICAS-related large vessel occlusion stroke, adjunctive angioplasty and/or stenting following mechanical thrombectomy may enhance vessel recanalization and improve functional outcomes without increasing hemorrhagic complications. Clinicians should consider vessel-directed therapies in selected patients, especially those with significant stenosis, to reduce the risk of reocclusion and recurrent stroke.
Conclusion
Mechanical thrombectomy combined with angioplasty and/or stenting appears to be a safe and effective strategy to improve recanalization and functional outcomes in ICAS-LVO stroke patients. Further randomized controlled trials are warranted to confirm these findings and optimize treatment protocols.
An aneurysm can develop anywhere in the brain’s network of blood vessels. It occurs when a section of an artery wall weakens, causing the blood flowing through the area to put additional pressure on the artery wall.
