Submaximal angioplasty in the treatment of patients with symptomatic ICAD: a systematic review and meta-analysis

J Neurointerv Surg. 2020 Apr;12(4):380-385. doi: 10.1136/neurintsurg-2019-015451. Epub 2019 Nov 20.


Introduction: Management approaches for intracranial atherosclerosis include medical, surgical, or endovascular treatment. Among endovascular treatments, recent studies have stated that submaximal angioplasty (SA) may offer considerable benefits and be a promising alternative to aggressive medical therapyand/or stenting in the treatment of intracranial atherosclerotic disease (ICAD).

Objective: To investigate the rates of periprocedural and long-term cerebrovascular accidents, mortality, and restenosis in patients with symptomatic ICAD who were treated with SA.

Methods: An electronic database search was performed for relevant studies that reported clinical outcomes of patients with ICAD following SA. Outcomes of interest were incidence of transient ischemic attack, intracerebral hemorrhage, stroke, and mortality in the periprocedural period and at 1 year. The periprocedural period was defined as the time from SA until 30 days after the procedure. Technical success and restenosis rates after the procedure were also analyzed.

Results: A total of 19 studies with 777 patients were identified. The technical success rate was 93% (95% CI 85% to 98%). The incidence of 30-day and 1-year stroke (all types) was 3% (95% CI 1% to 5%) and 5% (95% CI 4% to 8%), respectively. Thirty-day and 1-year mortality was found to be 1% (95% CI 0% to 2%) and 2% (95% CI 0% to 4%), respectively. The combined incidence of stroke or death was 5% (95% CI 3% to 8%) at 30 days, and 9% (95% CI 7% to 12%) at 1 year.

Conclusion: The findings suggest that SA might be a promising alternative treatment in the treatment of symptomatic ICAD due to its favorable technical profile, periprocedural safety, and long-term efficacy. A randomized clinical trial is warranted to compare the safety and efficacy of SA with 'gold standard' medical treatment.

Keywords: angioplasty, balloon; endovascular procedures; intracranial arteriosclerosis; stroke; treatment outcome.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Angioplasty / adverse effects
  • Angioplasty / methods*
  • Angioplasty / trends*
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / surgery
  • Humans
  • Intracranial Arteriosclerosis / diagnostic imaging*
  • Intracranial Arteriosclerosis / epidemiology
  • Intracranial Arteriosclerosis / surgery*
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / epidemiology
  • Ischemic Attack, Transient / surgery
  • Stents / adverse effects
  • Stents / trends
  • Stroke / diagnostic imaging
  • Stroke / epidemiology
  • Stroke / surgery
  • Treatment Outcome