Efficacy and Safety of Endovascular Recanalization for Non-acute Intracranial Arterial Occlusion: A Systematic Review and Meta-Analysis.

Abstract

The clinical efficacy of endovascular recanalization in patients with non-acute intracranial arterial occlusion (NAICAO) remains controversial. We conducted a systematic search in 3 databases (PubMed, EMBASE, and Web of science core) for endovascular recanalization for the treatment of NAICAO series cases according to PRISMA guidelines. Twenty-three articles with 1571 patients were included, with 1529 undergoing endovascular recanalization and 42 receiving conservative drug therapy alone. The overall success rate of endovascular recanalization was 87% (95% CI: 0.84-0.91, I² = 78%); the rate of periprocedural complications was 13% (95% CI: 0.10-0.15, I² = 48%); the periprocedural mortality rate was 0% (95% CI: 0.00-0.01, I² = 0%); and imaging follow-up in patients with successful recanalization showed that overall restenosis and reocclusion rate were 15% (95% CI: 0.13-0.18, I² = 17%); long-term follow-up stroke recurrence and mortality in the successful recanalization group was 7% (95% CI: 0.04-0.09, I² = 67%); and in long-term follow-up stroke recurrence and mortality were significantly lower in the successful recanalization group than in the failure to recanalize group (odds ratio [OR]: 0.15, 95% CI: 0.06-0.37, I² = 45%, P < 0.01). In a subgroup analysis of technical success, the success rate of anterior circulation did not differ from that of posterior circulation (OR:1.45,95% CI: 0.95-2.20, I² = 0%, P = 0.08); similarly, there was no difference in the rate of perioperative complications between anterior and posterior circulation (OR: 1.25,95% CI: 0.67-2.31, I² = 0%, P = 0.48). In NAICAO, endovascular recanalization presents a good safety and efficacy. Endovascular recanalization could be another option for patients with NAICAO ineffective on medical treatment.