Angioplasty with stenting for intracranial atherosclerosis: a systematic review.

OBJECTIVE: Intracranial artery stenosis can be fatal, requiring fast, safe and effective intervention. The introduction of the Wingspan (TM) stent system with Gateway (TM) percutaneous transluminal angioplasty balloon catheter has made intracranial intervention possible in a clinical trial setting. This systematic review planned to identify and review all randomized controlled trials comparing angioplasty and stenting of intracranial arteries with standard medical care. METHODS: Electronic databases and relevant records were examined for possible trials using predefined inclusion and exclusion criteria. RESULTS: A total of 3661 records were identified by searching several English language databases and other sources including Chinese academic journals. The recently discontinued Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) trial was the single qualifying study and showed clear advantage of medical management over percutaneous transluminal angioplasty and stenting (PTAS). CONCLUSIONS: The SAMPRASS trial indicated that PTAS is associated with high complication and morbidity rates. Definitive recommendations cannot be made until convincing results from additional robustly designed randomized trials become available.