Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 3;2(2):CD013267.
doi: 10.1002/14651858.CD013267.pub3.

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis

Jichang Luo  1   2 , Tao Wang  1   2 , Kun Yang  3 , Xue Wang  4 , Ran Xu  1   2 , Haozhi Gong  2   1 , Xiao Zhang  1   2 , Jie Wang  1   2 , Renjie Yang  1   2 , Peng Gao  1   2 , Yan Ma  1   2 , Liqun Jiao  1   2   5
Affiliations
Review

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis

Jichang Luo et al. Cochrane Database Syst Rev. .

Abstract

Background: Intracranial artery stenosis (ICAS) is an arterial narrowing in the brain that can cause stroke. Endovascular therapy (ET) and conventional medical treatment (CMT) may prevent recurrent ischaemic stroke caused by ICAS. However, there is no consensus on the best treatment for people with ICAS.

Objectives: To evaluate the safety and efficacy of endovascular therapy plus conventional medical treatment compared with conventional medical treatment alone for the management of symptomatic intracranial artery stenosis.

Search methods: We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, four other databases, and three trials registries on 16 August 2022. We contacted study authors and researchers when we required additional information.

Selection criteria: We included randomised controlled trials (RCTs) comparing ET plus CMT with CMT alone for the treatment of symptomatic ICAS. ET modalities included angioplasty alone, balloon-mounted stent, and angioplasty followed by placement of a self-expanding stent. CMT included antiplatelet therapy in addition to control of risk factors such as hypertension, hyperlipidaemia, and diabetes.

Data collection and analysis: Two review authors independently screened the records to select eligible RCTs, then extracted data from them. We resolved any disagreements through discussion, reaching consensus decisions among the full team. We assessed risk of bias and applied the GRADE approach to assess the certainty of the evidence. The primary outcome was death by any cause or non-fatal stroke of any type within three months of randomisation. Secondary outcomes included all-cause death or non-fatal stroke of any type occurring more than three months after randomisation, ipsilateral stroke, transient ischaemic attack, ischaemic stroke, haemorrhagic stroke, death, restenosis, dependency, and health-related quality of life.

Main results: We included four RCTs with 989 participants who had symptomatic ICAS, with an age range of 18 to 85 years. We identified two ongoing RTCs. All trials had high risk of performance bias, as it was impossible to blind participants and personnel to the intervention. Three trials were terminated early. One trial was at high risk of attrition bias because of substantial loss to follow-up after one year and a high proportion of participants transferring from ET to CMT. The certainty of evidence ranged from low to moderate; we downgraded for imprecision. Compared to CMT alone, ET plus CMT probably increases the risk of short-term death or stroke (risk ratio (RR) 2.93, 95% confidence interval (CI) 1.81 to 4.75; 4 RCTs, 989 participants; moderate certainty), short-term ipsilateral stroke (RR 3.26, 95% CI 1.94 to 5.48; 4 RCTs, 989 participants; moderate certainty), short-term ischaemic stroke (RR 2.24, 95% CI 1.30 to 3.87; 4 RCTs, 989 participants; moderate certainty), and long-term death or stroke (RR 1.49, 95% CI 1.12 to 1.99; 4 RCTs, 970 participants; moderate certainty). Compared to CMT alone, ET plus CMT may increase the risk of short-term haemorrhagic stroke (RR 13.49, 95% CI 2.59 to 70.15; 4 RCTs, 989 participants; low certainty), short-term death (RR 5.43, 95% CI 1.21 to 24.40; 4 RCTs, 989 participants; low certainty), and long-term haemorrhagic stroke (RR 7.81, 95% CI 1.43 to 42.59; 3 RCTs, 879 participants; low certainty). It is unclear if ET plus CMT compared with CMT alone has an effect on the risk of short-term transient ischaemic attack (RR 0.79, 95% CI 0.30 to 2.07; 3 RCTs, 344 participants; moderate certainty), long-term transient ischaemic attack (RR 1.05, 95% CI 0.50 to 2.19; 3 RCTs, 335 participants; moderate certainty), long-term ipsilateral stroke (RR 1.78, 95% CI 1.00 to 3.17; 4 RCTs, 970 participants; moderate certainty), long-term ischaemic stroke (RR 1.56, 95% CI 0.77 to 3.16; 4 RCTs, 970 participants; moderate certainty), long-term death (RR 1.61, 95% CI 0.77 to 3.38; 4 RCTs, 951 participants; moderate certainty), and long-term dependency (RR 1.51, 95% CI 0.93 to 2.45; 4 RCTs, 947 participants; moderate certainty). No subgroup analyses significantly modified the effect of ET plus CMT versus CMT alone. The trials included no data on restenosis or health-related quality of life.

Authors' conclusions: This review provides moderate-certainty evidence that ET plus CMT compared with CMT alone increases the risk of short-term stroke and death in people with recent symptomatic severe ICAS. This effect was still apparent at long-term follow-up but appeared to be due to the early risks of ET; therefore, there may be no clear difference between the interventions in terms of their effects on long-term stroke and death. The impact of delayed ET intervention (more than three weeks after a qualifying event) warrants further study.

PubMed Disclaimer

Conflict of interest statement

JL: none TW: none KY: none XW: none RX: none HG: none XZ: none JW: none RY: none PG: none YM: none LJ: none

Figures

1
1
Study flow diagram. 
ECAS: extracranial artery stenosis.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Primary outcome: short‐term death or stroke, Outcome 1: Short‐term death or stroke
1.2
1.2. Analysis
Comparison 1: Primary outcome: short‐term death or stroke, Outcome 2: Subgroup analysis: types of endovascular therapy
1.3
1.3. Analysis
Comparison 1: Primary outcome: short‐term death or stroke, Outcome 3: Subgroup analysis: time interval from qualifying event to intervention
2.1
2.1. Analysis
Comparison 2: Other outcomes, Outcome 1: Short‐term ipsilateral stroke
2.2
2.2. Analysis
Comparison 2: Other outcomes, Outcome 2: Short‐term ischaemic stroke
2.3
2.3. Analysis
Comparison 2: Other outcomes, Outcome 3: Short‐term haemorrhagic stroke
2.4
2.4. Analysis
Comparison 2: Other outcomes, Outcome 4: Short‐term TIA
2.5
2.5. Analysis
Comparison 2: Other outcomes, Outcome 5: Short‐term death
2.6
2.6. Analysis
Comparison 2: Other outcomes, Outcome 6: Long‐term death or stroke
2.7
2.7. Analysis
Comparison 2: Other outcomes, Outcome 7: Long‐term ipsilateral stroke
2.8
2.8. Analysis
Comparison 2: Other outcomes, Outcome 8: Long‐term ischaemic stroke
2.9
2.9. Analysis
Comparison 2: Other outcomes, Outcome 9: Long‐term haemorrhagic stroke
2.10
2.10. Analysis
Comparison 2: Other outcomes, Outcome 10: Long‐term TIA
2.11
2.11. Analysis
Comparison 2: Other outcomes, Outcome 11: Long‐term death
2.12
2.12. Analysis
Comparison 2: Other outcomes, Outcome 12: Long‐term dependency
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

References

References to studies included in this review

Chimowitz 2011 {published data only}
    1. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. New England Journal of Medicine 2011;365(11):993-1003. - PMC - PubMed
Gao 2022 {published data only}
    1. Gao P, Wang T, Wang D, Liebeskind DS, Shi H, Li T, et al. Effect of stenting plus medical therapy vs medical therapy alone on risk of stroke and death in patients with symptomatic intracranial stenosis: the CASSISS randomized clinical trial. JAMA 2022;328(6):534-42. - PMC - PubMed
Miao 2012 {published data only}
    1. Miao Z, Jiang L, Wu H, Bao Y, Jiao L, Li S, et al. Randomized controlled trial of symptomatic middle cerebral artery stenosis: endovascular versus medical therapy in a Chinese population. Stroke 2012;43(12):3284-90. - PubMed
Zaidat 2015 {published data only}
    1. Zaidat OO, Fitzsimmons BF, Woodward BK, Wang Z, Killer-Oberpfalzer M, Wakhloo A, et al. Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial. JAMA 2015;313(12):1240-8. - PubMed

References to studies excluded from this review

Compter 2015 {published data only}
    1. Compter A, Worp HB, Schonewille WJ, Vos JA, Boiten J, Nederkoorn PJ, et al. Stenting versus medical treatment in patients with symptomatic vertebral artery stenosis: a randomised open-label phase 2 trial. Lancet Neurology 2015;14(6):606-14. - PubMed
Coward 2007 {published data only}
    1. Coward LJ, McCabe DJ, Ederle J, Featherstone RL, Clifton A, Brown MM. Long-term outcome after angioplasty and stenting for symptomatic vertebral artery stenosis compared with medical treatment in the Carotid And Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Stroke 2007;38(5):1526-30. - PubMed
Markus 2017 {published data only}
    1. Markus HS, Larsson SC, Kuker W, Schulz UG, Ford I, Rothwell PM, et al. Stenting for symptomatic vertebral artery stenosis: the Vertebral Artery Ischaemia Stenting Trial. Neurology 2017;89(12):1229-36. - PMC - PubMed

References to ongoing studies

Cui 2016 {published data only}
    1. Cui XP, Lin M, Mu JS, Ye JX, He WQ, Fu ML, et al. Angioplasty and stenting for patients with symptomatic intracranial atherosclerosis: study protocol of a randomised controlled trial. BMJ Open 2016;6(11). - PMC - PubMed
Yang 2018 {published data only}
    1. Yang QW, Shuai J. A multicenter randomized trial of stenting plus standard medical treatment versus standard medical treatment alone for symptomatic intracranial atherosclerotic stenosis [A randomized trial of Stenting for Symptomatic Intracranial STenosis (ASSIST)]. Chinese Clinical Trial Registry 2018. [ChiCTR1800015766]

Additional references

Abou‐Chebl 2012
    1. Abou-Chebl A, Steinmetz H. Critique of "Stenting versus aggressive medical therapy for intracranial arterial stenosis" by Chimowitz et al in the New England Journal of Medicine. Stroke 2012;43(2):616-20. - PubMed
Abualhasan 2019
    1. Abualhasan A, Abd-Allah F, Pero G, Sobh K, Mansour O, El-Serafy O, et al. Intracranial stenting: is it still an option for treatment of patients with intracranial atherosclerosis? Frontiers in Neurology 2019;10:1248. - PMC - PubMed
Alexander 2019
    1. Alexander MJ, Zauner A, Chaloupka JC, Baxter B, Callison RC, Gupta R, et al. WEAVE Trial: final results in 152 on-label patients. Stroke 2019;50(4):889-94. - PubMed
Alexander 2021
    1. Alexander MJ, Zauner A, Gupta R, Alshekhlee A, Fraser JF, Toth G, et al. The WOVEN trial: Wingspan One-year Vascular Events and Neurologic outcomes. Journal of Neurointerventional Surgery 2021;13(4):307-10. - PubMed
An 2002
    1. An H, Lin W. Cerebral oxygen extraction fraction and cerebral venous blood volume measurements using MRI: effects of magnetic field variation. Magnetic Resonance in Medicine 2002;47(5):958-66. [PMID: ] - PubMed
Aoki 1995
    1. Aoki S, Shirouzu I, Sasaki Y, Okubo T, Hayashi N, Machida T, et al. Enhancement of the intracranial arterial wall at MR imaging: relationship to cerebral atherosclerosis. Radiology 1995;194(2):477-81. [PMID: ] - PubMed
Arenillas 2011
    1. Arenillas JF. Intracranial atherosclerosis: current concepts. Stroke 2011;42(1 Suppl):S20-3. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Banerjee 2017
    1. Banerjee C, Chimowitz MI. Stroke caused by atherosclerosis of the major intracranial arteries. Circulation Research 2017;120(3):502-13. - PMC - PubMed
Bang 2014
    1. Bang OY. Intracranial atherosclerosis: current understanding and perspectives. Journal of Stroke 2014;16(1):27-35. - PMC - PubMed
Benjamin 2017
    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2017 update: a report from the American Heart Association. Circulation 2017;135(10):e146-603. - PMC - PubMed
Berkefeld 2009
    1. Berkefeld J, Zanella FE. Intracranial stenting of atherosclerotic stenoses: current status and perspectives. Klinische Neuroradiologie 2009;19(1):38-44. - PubMed
Boissel 1999
    1. Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use [Apercu sur la problematique des indices d'efficacite therapeutique, 3: comparaison des indices et utilisation. Groupe d'Etude des Indices D'efficacite]. Therapie 1999;54(4):405-11. [PMID: ] - PubMed
Carson 2011
    1. Carson AP, Howard G, Burke GL, Shea S, Levitan EB, Muntner P. Ethnic differences in hypertension incidence among middle-aged and older adults: the multi-ethnic study of atherosclerosis. Hypertension 2011;57(6):1101-7. [PMID: ] - PMC - PubMed
Chatterjee 2015
    1. Chatterjee AR, Derdeyn CP. Stenting in intracranial stenosis: current controversies and future directions. Current Atherosclerosis Reports 2015;17(8):48. - PubMed
Chimowitz 2005
    1. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. New England Journal of Medicine 2005;352(13):1305-16. [PMID: ] - PubMed
Chimowitz 2015
    1. Chimowitz MI, Derdeyn CP. Endovascular therapy for atherosclerotic intracranial arterial stenosis: back to the drawing board. JAMA 2015;313(12):1219-20. [PMID: ] - PubMed
Chu 2004
    1. Chu B, Kampschulte A, Ferguson MS, Kerwin WS, Yarnykh VL, O'Brien KD, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 2004;35(5):1079-84. [PMID: ] - PubMed
Connors 2014
    1. Connors JJ 3rd, Wojak JC, Hoppe BH. The technique of endovascular intracranial revascularization. Frontiers in Neurology 2014;5:246. [PMID: ] - PMC - PubMed
Cruz‐Flores 2006
    1. 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] [PMID: ] - DOI - PMC - PubMed
Derdeyn 1998
    1. Derdeyn CP, Powers WJ, Grubb RL Jr. Hemodynamic effects of middle cerebral artery stenosis and occlusion. American Journal of Neuroradiology 1998;19(8):1463-9. [PMID: ] - PMC - PubMed
Derdeyn 1999
    1. Derdeyn CP, Grubb RL Jr, Powers WJ. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology 1999;53(2):251-9. [PMID: ] - PubMed
Derdeyn 2007
    1. Derdeyn CP. Mechanisms of ischemic stroke secondary to large artery atherosclerotic disease. Neuroimaging Clinics of North America 2007;17(3):303-11, vii-viii. [PMID: ] - PubMed
Derdeyn 2013
    1. Derdeyn C, Fiorella D, Lynn M, Rumboldt Z, Cloft H, Gibson D, et al. Mechanisms of stroke after intracranial angioplasty and stenting in the SAMMPRIS trial. Neurosurgery 2013;72(5):777-95. - PMC - PubMed
Derdeyn 2014
    1. Derdeyn CP, Chimowitz MI, Lynn MJ, Fiorella D, Turan TN, Janis LS, et al. Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trial. Lancet 2014;383(9914):333-41. - PMC - PubMed
Easton 2009
    1. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009;40(6):2276-93. - PubMed
EC/IC Bypass Study Group 1985
    1. EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. New England Journal of Medicine 1985;313(19):1191-200. - PubMed
Feldmann 1990
    1. Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, et al. Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990;40(10):1541-5. [PMID: ] - PubMed
Feldmann 2007
    1. Feldmann E, Wilterdink JL, Kosinski A, Lynn M, Chimowitz MI, Sarafin J, et al. The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) trial. Neurology 2007;68(24):2099-106. [PMID: ] - PubMed
Gao 2016
    1. Gao P, Wang D, Zhao Z, Cai Y, Li T, Shi H, et al. Multicenter prospective trial of stent placement in patients with symptomatic high-grade intracranial stenosis. American Journal of Neuroradiology 2016;37(7):1275-80. - PMC - PubMed
Gorelick 2008
    1. Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke 2008;39(8):2396-9. [PMID: ] - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), (accessed 14 August 2022). Available at gradepro.org.
Gupta 2006
    1. Gupta R, Al-Ali F, Thomas AJ, Horowitz MB, Barrow T, Vora NA, et al. Safety, feasibility, and short-term follow-up of drug-eluting stent placement in the intracranial and extracranial circulation. Stroke 2006;37(10):2562-6. [PMID: ] - PubMed
Hankey 2002
    1. Hankey GJ. Warfarin-Aspirin Recurrent Stroke Study (WARSS) trial: is warfarin really a reasonable therapeutic alternative to aspirin for preventing recurrent noncardioembolic ischemic stroke? Stroke 2002;33(6):1723-6. [PMID: ] - PubMed
Hatsukami 2000
    1. Hatsukami TS, Ross R, Polissar NL, Yuan C. Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation 2000;102(9):959-64. [PMID: ] - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston MS, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from: training.cochrane.org/handbook.
Hirai 2002
    1. Hirai T, Korogi Y, Ono K, Nagano M, Maruoka K, Uemura S, et al. Prospective evaluation of suspected stenoocclusive disease of the intracranial artery: combined MR angiography and CT angiography compared with digital subtraction angiography. American Journal of Neuroradiology 2002;23(1):93-101. [PMID: ] - PMC - PubMed
Holmstedt 2013
    1. Holmstedt CA, Turan TN, Chimowitz MI. Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment. Lancet Neurology 2013;12(11):1106-14. - PMC - PubMed
Hou 2009
    1. Hou WH, Liu X, Duan YY, Wang J, Sun SG, Deng JP, et al. Evaluation of transcranial color-coded duplex sonography for cerebral artery stenosis or occlusion. Cerebrovascular Diseases 2009;27(5):479-84. [PMID: ] - PubMed
Huang 2014
    1. Huang Y, Cai X, Li Y, Su L, Mai W, Wang S, et al. Prehypertension and the risk of stroke: a meta-analysis. Neurology 2014;82(13):1153-61. [PMID: ] - PubMed
Jiang 2007
    1. Jiang WJ, Xu XT, Du B, Dong KH, Jin M, Wang QH, et al. Comparison of elective stenting of severe vs moderate intracranial atherosclerotic stenosis. Neurology 2007;68(6):420-6. [PMID: ] - PubMed
Kasner 2006
    1. Kasner SE, Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 2006;113(4):555-63. [PMID: ] - PubMed
Kernan 2014
    1. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(7):2160-236. - PubMed
Kleindorfer 2021
    1. Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: a guideline From the American Heart Association/American Stroke Association. Stroke 2021;52:e364-e467. [PMID: ] - PubMed
Kurre 2012
    1. Kurre W, Brassel F, Bruning R, Buhk J, Eckert B, Horner S, et al. Complication rates using balloon-expandable and self-expanding stents for the treatment of intracranial atherosclerotic stenoses: analysis of the INTRASTENT multicentric registry. Neuroradiology 2012;54(1):43-50. [PMID: ] - PubMed
Leung 1993
    1. Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC. Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels. Stroke 1993;24(6):779-86. [PMID: ] - PubMed
Liu 1996
    1. Liu HM, Tu YK, Yip PK, Su CT. Evaluation of intracranial and extracranial carotid steno-occlusive diseases in Taiwan Chinese patients with MR angiography: preliminary experience. Stroke 1996;27(4):650-3. - PubMed
Luo 2018
    1. Luo J, Wang T, Gao P, Krings T, Jiao L. Endovascular treatment of intracranial atherosclerotic stenosis: current debates and future prospects. Frontiers in Neurology 2018;9:666. [PMID: ] - PMC - PubMed
Ma 2013
    1. Ma N, Mo DP, Gao F, Miao ZR. Endovascular recanalization for chronic symptomatic middle cerebral artery total occlusion. Journal of Neurointerventional Surgery 2013;5(3):e15. [PMID: ] - PMC - PubMed
Manzano 2012
    1. Manzano JJ, De Silva DA, Pascual JL, Chang HM, Wong MC, Chen CP. Associations of ankle-brachial index (ABI) with cerebral arterial disease and vascular events following ischemic stroke. Atherosclerosis 2012;223(1):219-22. [PMID: ] - PubMed
Marks 2012
    1. Marks MP. Is there a future for endovascular treatment of intracranial atherosclerotic disease after Stenting and Aggressive Medical Management for Preventing Recurrent Stroke and Intracranial Stenosis (SAMMPRIS)? Stroke 2012;43(2):580-4. [PMID: ] - PubMed
Miao 2015
    1. Miao Z, Zhang Y, Shuai J, Jiang C, Zhu Q, Chen K, et al. Thirty-day outcome of a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China. Stroke 2015;46(10):2822-9. - PubMed
Natarajan 2010
    1. Natarajan SK, Ogilvy CS, Hopkins LN, Siddiqui AH, Levy EI. Initial experience with an everolimus-eluting, second-generation drug-eluting stent for treatment of intracranial atherosclerosis. Journal of Neurointerventional Surgery 2010;2(2):104-9. [PMID: ] - PubMed
Padalia 2018
    1. Padalia A, Sambursky JA, Skinner C, Moureiden M. Percutaneous transluminal angioplasty with stent placement versus best medical therapy alone in symptomatic intracranial arterial stenosis: a best evidence review. Cureus 2018;10(7):e2988. - PMC - PubMed
Page 2021
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Systematic Reviews 2021;10(1):1-11. [PMID: ] - PMC - PubMed
Patel 2013
    1. Patel IJ, Bezerra HG, Costa MA, Fujino Y, Hsu DP. Novel use of optical coherence tomography. Journal of Neurointerventional Surgery 2013;5(6):e41. [PMID: ] - PubMed
Qureshi 2009
    1. Qureshi AI, Feldmann E, Gomez CR, Johnston SC, Kasner SE, Quick DC, et al. Intracranial atherosclerotic disease: an update. Annals of Neurology 2009;66(6):730-8. - PubMed
Qureshi 2014
    1. Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet 2014;383(9921):984-98. - PubMed
Resch 1970
    1. Resch JA, Loewenson RB, Baker AB. Physical factors in the pathogenesis of cerebral atherosclerosis. Stroke 1970;1(2):77-85. [PMID: ] - PubMed
Review Manager 2020 [Computer program]
    1. Review Manager 5 (RevMan 5). Version 5.4. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2020.
Ritz 2014
    1. Ritz K, Denswil NP, Stam OC, Lieshout JJ, Daemen MJ. Cause and mechanisms of intracranial atherosclerosis. Circulation 2014;130(16):1407-14. [PMID: ] - PubMed
Saam 2005
    1. Saam T, Ferguson MS, Yarnykh VL, Takaya N, Xu D, Polissar NL, et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arteriosclerosis, Thrombosis, and Vascular Biology 2005;25(1):234-9. [PMID: ] - PubMed
Sacco 1995
    1. Sacco RL, Kargman DE, Gu Q, Zamanillo MC. Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995;26(1):14-20. - PubMed
Sacco 2013
    1. Sacco R, Kasner S, Broderick J, Caplan L, Connors J, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44(7):2064-89. [PMID: ] - PMC - PubMed
Saini 2021
    1. Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology 2021;97(20 Suppl 2):S6-S16. - PubMed
Sloan 2004
    1. Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004;62(9):1468-81. [PMID: ] - PubMed
Solberg 1972
    1. Solberg LA, McGarry PA. Cerebral atherosclerosis in Negroes and Caucasians. Atherosclerosis 1972;16(2):141-54. [PMID: ] - PubMed
Stevens 2008
    1. Stevens J, Truesdale KP, Katz EG, Cai J. Impact of body mass index on incident hypertension and diabetes in Chinese Asians, American Whites, and American Blacks: the People's Republic of China Study and the Atherosclerosis Risk in Communities Study. American Journal of Epidemiology 2008;167(11):1365-74. [PMID: ] - PMC - PubMed
Tsivgoulis 2016
    1. Tsivgoulis G, Katsanos AH, Magoufis G, Kargiotis O, Papadimitropoulos G, Vadikolias K, et al. Percutaneous transluminal angioplasty and stenting for symptomatic intracranial arterial stenosis: a systematic review and meta-analysis. Therapeutic Advances in Neurological Disorders 2016;9(5):351-8. - PMC - PubMed
Turan 2010
    1. Turan TN, Makki AA, Tsappidi S, Cotsonis G, Lynn MJ, Cloft HJ, et al. Risk factors associated with severity and location of intracranial arterial stenosis. Stroke 2010;41(8):1636-40. [PMID: ] - PMC - PubMed
Turan 2015
    1. Turan TN, LeMatty T, Martin R, Chimowitz MI, Rumboldt Z, Spampinato MV, et al. Characterization of intracranial atherosclerotic stenosis using high-resolution MRI study – rationale and design. Brain and Behavior 2015;5(12):e00397. [PMID: ] - PMC - PubMed
Van der Kolk 2015
    1. Van der Kolk AG, Zwanenburg JJ, Denswil NP, Vink A, Spliet WG, Daemen MJ, et al. Imaging the intracranial atherosclerotic vessel wall using 7T MRI: initial comparison with histopathology. American Journal of Neuroradiology 2015;36(4):694-701. [PMID: ] - PMC - PubMed
Waddy 2009
    1. Waddy SP, Cotsonis G, Lynn MJ, Frankel MR, Chaturvedi S, Williams JE, et al. Racial differences in vascular risk factors and outcomes of patients with intracranial atherosclerotic arterial stenosis. Stroke 2009;40(3):719-25. [PMID: ] - PMC - PubMed
Wang 2014
    1. Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke 2014;45(3):663-9. - PubMed
White 2005
    1. White H, Boden-Albala B, Wang C, Elkind MS, Rundek T, Wright CB, et al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005;111(10):1327-31. - PubMed
WHO 2017
    1. World Health Organization. Global Health Observatory (GHO) data. www.who.int/gho/en (accessed prior to 7 February 2019).
Wityk 1996
    1. Wityk RJ, Lehman D, Klag M, Coresh J, Ahn H, Litt B. Race and sex differences in the distribution of cerebral atherosclerosis. Stroke 1996;27(11):1974-80. [PMID: ] - PubMed
Wong 2006
    1. Wong LK. Global burden of intracranial atherosclerosis. International Journal of Stroke 2006;1(3):158-9. [PMID: ] - PubMed
Wong 2007
    1. Wong KS, Ng PW, Tang A, Liu R, Yeung V, Tomlinson B. Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients. Neurology 2007;68(23):2035-8. [PMID: ] - PubMed
Yu 2014
    1. Yu SC, Leung TW, Lee KT, Wong LK. Angioplasty and stenting of intracranial atherosclerosis with the Wingspan system: 1-year clinical and radiological outcome in a single Asian center. Journal of Neurointerventional Surgery 2014;6(2):96-102. - PMC - PubMed
Zacharatos 2010
    1. Zacharatos H, Hassan AE, Qureshi AI. Intravascular ultrasound: principles and cerebrovascular applications. American Journal of Neuroradiology 2010;31(4):586-97. [PMID: ] - PMC - PubMed
Zhang 2017
    1. Zhang Q, Dong K, Song H. Comparison of stent versus medical therapy for symptomatic patients with intracranial atherosclerotic stenosis: a meta-analysis. Journal of the Neurological Sciences 2017;372:272-8. - PubMed

References to other published versions of this review

Wang 2019
    1. Wang T, Yang K, Wang X, Luo J, Gao P, Ma Y, et al. Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis. Cochrane Database of Systematic Reviews 2019, Issue 2. Art. No: CD013267. [DOI: 10.1002/14651858.CD013267] - DOI - PMC - PubMed
Wang 2020
    1. Wang T, Luo JC, Wang X, Yang K, Jadhav V, Gao P, et al. Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No: CD013267. [DOI: 10.1002/14651858.CD013267.pub2] - DOI - PMC - PubMed