Angioplasty and/or stenting after thrombectomy in patients with large vessel occlusion associated with underlying intracranial atherosclerotic stenosis: a meta-analysis and systematic review.

Abstract

Intracranial atherosclerotic stenosis-related large vessel occlusion (ICAS-LVO) is a leading cause of acute large vessel occlusion stroke. For patients suffering from ICAS-LVO stroke, the first-line treatment is mechanical thrombectomy (MT). However, whether balloon angioplasty and/or stenting should be performed after MT in patients with ICAS-LVO stroke remains uncertain in clinical practice. In this study, a meta-analysis and systematic review was performed to assess the efficacy and safety of angioplasty and/or stenting after MT. A thorough search of the PubMed, Web of Science, Cochrane, and Scopus databases from inception to February 28, 2025, was performed to retrieve clinical trials comparing angioplasty and/or stenting plus MT versus MT alone. Vessel recanalization, functional independence at 90 days, early neurological deterioration, symptomatic intracranial hemorrhage (ICH), asymptomatic ICH, any ICH, and mortality at 90 days were analyzed. RevMan version 5.4 was used to calculate the pooled risk ratio (RR) and 95% confidence interval (CI). The analysis included nine studies. No significant difference was observed between MT + angioplasty/stenting and MT alone in terms of vessel recanalization (RR = 1.03, 95%CI = 0.97-1.11, p = 0.33), symptomatic ICH (RR = 1.06, 95%CI = 0.65-1.71, p = 0.82), asymptomatic ICH (RR = 1.17, 95%CI = 0.86-1.60, p = 0.33), any ICH (RR = 0.97, 95%CI = 0.77-1.21, p = 0.79), and mortality at 90 days (RR = 0.97, 95%CI = 0.70-1.34, p = 0.84). Angioplasty and/or stent plus MT significantly increased the likelihood of functional independence (mRS 0-2) at 90 days (RR = 1.24, 95%CI = 1.11-1.38, p < 0.001) and decreased early neurological deterioration (RR = 0.60, 95% CI = 0.37-0.95, p = 0.03). Angioplasty and/or stent after MT was associated with significantly better functional independence and reduced early neurological deterioration compared to MT alone a without significant adverse events.