Related Experiment Video
Updated: Aug 7, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Angioplasty for intracranial artery stenosis
1Saint Louis University School of Medicine, Department of Neurology, 3635 Vista Avenue, St. Louis, Missouri 63110, USA. cruzfls@slu.edu
Insights
Angioplasty for intracranial artery stenosis is feasible but lacks evidence of effectiveness and carries risks. More randomized controlled trials are needed to assess its safety and efficacy in preventing recurrent strokes.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Intracranial artery stenosis is a significant cause of ischemic stroke, with high rates of recurrent vascular events.
- Angioplasty with or without stenting is a potential intervention to restore vessel patency.
- Systematic evaluation of the safety and efficacy of this procedure is lacking.
Purpose of the Study:
- To evaluate the efficacy and safety of angioplasty plus best medical treatment versus best medical treatment alone.
- To determine the effectiveness in preventing recurrent ischemic strokes, death, and vascular events in patients with acute ischemic stroke or TIA due to intracranial artery stenosis.
Main Methods:
- Comprehensive literature search of multiple databases including Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, EMBASE, and Science Citation Index up to March 2006.
- Inclusion criteria focused on randomized or controlled studies comparing angioplasty (with or without stent) plus best medical care against best medical care alone, with available data on clinical endpoints.
- Data extraction and quality assessment were performed independently by two reviewers.
Main Results:
- No randomized controlled trials were identified.
- Analysis included 79 open-label case series with three or more cases.
- The procedure demonstrated a perioperative stroke rate of 7.9%, perioperative death rate of 3.4%, and a combined perioperative stroke or death rate of 9.5%.
Conclusions:
- Insufficient evidence currently exists to recommend routine angioplasty with or without stenting for stroke prevention in intracranial artery stenosis.
- While feasible, the procedure is associated with significant risks of morbidity and mortality.
- Randomized controlled trials are essential to establish the safety and effectiveness of angioplasty in preventing recurrent strokes.
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 Strategy:
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.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care