Intervention Review

Angioplasty for intracranial artery stenosis

  1. Salvador Cruz-Flores*,
  2. Alan L Diamond

Editorial Group: Cochrane Stroke Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 22 MAR 2006

DOI: 10.1002/14651858.CD004133.pub2


How to Cite

Cruz-Flores S, Diamond AL. Angioplasty for intracranial artery stenosis. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004133. DOI: 10.1002/14651858.CD004133.pub2.

Author Information

  1. Saint Louis University School of Medicine, Department of Neurology, St. Louis, Missouri, USA

*Salvador Cruz-Flores, Department of Neurology, Saint Louis University School of Medicine, 3635 Vista Avenue, St. Louis, Missouri, 63110, USA. cruzfls@slu.edu. cruz-fls@slucare1.sluh.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Intracranial artery stenosis causes up to 10% of all ischaemic strokes. The rate of recurrent vascular ischaemic events is very high. Angioplasty with or without stent placement is a feasible procedure to dilate the vessel affected. However, its safety and efficacy have not been systematically studied.

Objectives

To determine the efficacy and safety of angioplasty combined with best medical treatment compared with best medical treatment alone in patients with acute ischaemic stroke or transient ischaemic attack (TIA) resulting from intracranial artery stenosis for preventing recurrent ischaemic strokes, death, and vascular events.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched March 2006). In addition we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006), EMBASE (1980 to February 2006) and Science Citation Index (1945 to March 2006). To identify further published, unpublished and ongoing trials we searched reference lists of relevant articles and contacted authors and experts in the field.

Selection criteria

Randomised or otherwise controlled studies comparing best medical care plus angioplasty of the intracranial cerebral arteries, with or without stent placement, with best medical care alone. Studies were only included if data for clinical significant endpoints such as recurrent ischaemic stroke, haemorrhagic stroke and death were available.

Data collection and analysis

Two review authors selected trials for inclusion, and independently assessed trial quality and extracted data. Calculation of relative treatment effects with subgroup analysis was done if possible.

Main results

No randomised controlled trials were found. There were 79 articles of interest consisting of open-label case series with three or more cases. The safety profile of the procedure showed an overall perioperative rate of stroke of 7.9% (95% confidence intervals (CI) 5.5% to 10.4%), perioperative death of 3.4% (95% CI 2.0% to 4.8%), and perioperative stroke or death of 9.5% (95% CI 7.0% to 12.0%). No comments can be made on the effectiveness of the procedure.

Authors' conclusions

At present there is insufficient evidence to recommend angioplasty with or without stent placement in routine practice for the prevention of stroke in patients with intracranial artery stenosis. The descriptive studies show that the procedure is feasible although carries a significant morbidity and mortality risk. Evidence from randomised controlled trials is needed to assess the safety of angioplasty and its effectiveness in preventing recurrent stroke.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Angioplasty for intracranial artery stenosis

There is insufficient evidence to support the use of angioplasty for intracranial artery stenosis. Narrowing of the arteries inside the skull is a significant cause of stroke. Medical treatment for prevention consists of the control of risk factors such as high blood pressure, diabetes, and high cholesterol. Blood thinners are also used, but none has been demonstrated to be superior to another. Angioplasty, a procedure for opening narrowed arteries by means of a balloon or stent, is feasible but its safety and efficacy is not known. This review found no randomised controlled trials and no evidence to support the use of this procedure in routine practice. More research is needed to establish the role of this procedure in the treatment of this disease.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

血管整形術治療顱內動脈狹窄

顱內動脈狹窄造成高達10%的缺血性中風。血管缺血性事件的再發率是非常高的。有或無支架置放的血管整形術是一種可行的手術來擴張受影響的血管。但是,其安全性和有效性還沒有得到系統性的研究。

目標

要確定在因顱內動脈狹窄造成急性缺血性中風或短暫性腦缺血(TIA)的病人,以血管整形術結合最好的藥物治療和單獨最好的藥物治療在療效和安全性方面的相比,以預防缺血性中風,死亡和血管事件

搜尋策略

我們檢索了Cochrane腦中風組試驗註冊資料庫(搜尋至2006年3月)。此外,我們檢索了Cochrane中心臨床對照試驗(CENTRAL)(Cochrane圖書館1期,2006),MEDLINE(1966年至2006年3月),EMBASE(1980年至2006年2月)和科學引文索引(1945年至2006年3月)。為了進一步找出已發表,未發表和正在進行的試驗,我們搜尋了有關文章的參考文獻也和作者和在此領域的專家聯繫。

選擇標準

比較最好的藥物加顱內腦動脈血管整形術(有或無放置支架)比上單獨最好的藥物治療的隨機對照研究或其他對照研究. 研究只納入那些有臨床重要結果可供參考的試驗,如再發的缺血性中風,出血性中風和死亡。

資料收集與分析

兩名文獻評論家根據納入條件分別選擇臨床試驗,評估試驗品質並擷取資料. 相對治療效果與次分組分析在如果可能的話也會被計算。

主要結論

沒有隨機對照試驗被發現。有79篇文章內容是無對照組,有3個或更多個案的系列案例(openlabel case series)。在手術安全性方面,手術前後的整體中風率7.9%(95%可信區間(CI)5.5%至10.4%),手術前後死亡率是3.4%(95%CI為2.0%至4.8%),手術前後的中風或死亡率是9.5%(95%CI為7.0%至12.0%)。手術的功效並無法做出結論

作者結論

目前沒有足夠的證據來支持規則地施行有或無支架放置的血管整形術在顱內動脈狹窄以預防中風。描述性研究顯示,該手術是可行的,雖然有顯著地罹病率和死亡率風險。來自隨機對照試驗的證據是需要的,以評估血管整形術防止再發性中風的安全性和有效性。

翻譯人

本摘要由奇美醫院何乘彰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前沒有足夠證據來支持在顱內動脈狹窄者施行血管整形術:顱內狹窄的動脈是中風的重要原因。藥物治療以預防包括控制危險因子,如高血壓,糖尿病和高膽固醇。血液稀釋也被使用,但沒有一種方法被證明是比另一種方法優越。血管整形術是一種手術藉著一個氣球或支架撐開狹窄的動脈,是可行的但它的安全性和療效尚不清楚。本篇回顧沒有發現任何的隨機對照臨床試驗,所以沒有證據支持這一手術用於常規的實行。需要更多的研究以確定此手術治療這種疾病的功用