{
  "abstract": "Background Medically refractory intracranial atherosclerotic disease (ICAD) remains a leading cause of recurrent stroke worldwide. The SAMMPRIS trial raised concerns regarding the safety of intracranial stenting, demonstrating high periprocedural stroke and death rates. Since then, advances in device technology, operator experience, and patient selection have led to renewed interest in balloon-mounted stents (BMS), including bare-metal and drug-eluting platforms. We aimed to evaluate the safety and effectiveness of contemporary balloon-mounted stenting compared with historical medical management benchmarks from the SAMMPRIS trial.Methods A systematic PubMed search identified studies evaluating balloon-mounted stents for symptomatic, medically refractory ICAD from 2011 to 2026, representing the post-SAMMPRIS era. Studies involving self-expanding stents, rescue stenting after thrombectomy, or overlapping registry cohorts were excluded. Outcomes were pooled using random-effects proportional meta-analysis. Primary outcomes included 30-day stroke or death and 1-year stroke in the territory of the qualifying artery. Secondary analyses included 30-day mortality and 1-year mortality, when available. Results were compared with historical SAMMPRIS medical management benchmarks. Sensitivity analyses included leave-one-out approaches and exclusion of influential studies. A predefined subgroup analysis was performed including studies published from 2020-2026 to reflect contemporary practice.Results A total of 36 studies comprising 3,263 patients were included. The aggregate 30-day stroke/death rate was 6.5% , similar to the medical management trials (5.8%, p=0.8). Results were robust on leave-one-out sensitivity analysis, with minimal change in pooled estimates. In the 2020-2026 subgroup, 30-day stroke/death rates were numerically lower, with no significant difference compared with medical therapy (4.8% vs. 5.8%, p=0.4), suggesting improved contemporary safety profiles. When evaluating 1-year stroke in the target territory, BMS showed a rate of 11.2% (95% CI 8.6-14.4) which was not statistically different from medical management (13%, 95%CI: 3-38, p=0.3). In the 2020-2026 subgroup, there was a trend toward lower rate of 1-year recurrent stroke in the BMS group compared to medical management (9% vs. 13%, p=0.08).Conclusions In the post-SAMMPRIS era, balloon-mounted stenting for medically refractory ICAD demonstrates comparable periprocedural safety and long-term stroke risk relative to aggressive medical therapy. Contemporary data (2020-2026) suggest improved safety profiles, likely reflecting advances in technique and patient selection. While no statistically significant superiority over medical management was observed, there is a signal toward improved 1-year outcomes with balloon-mounted stents, supporting their potential role in carefully selected patients. Prospective studies are needed to better define patient subgroups most likely to benefit from this strategy.Disclosures L. Silveira: None. M. Jatty: None. A. Chacon: None. T. Ma: None. M. Motiwala: None. C. Nickele: None. L. Elijovich: None. J. Grossberg: None. A. Alawieh: None. N. Goyal: None.Abstract O-016 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "L Silveira"
    },
    {
      "affiliations": [
        "Neurology, University of Tennessee Health Sciences, Memphis, TN"
      ],
      "name": "M Jatty"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, GA"
      ],
      "name": "A Chacon"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, GA"
      ],
      "name": "T Ma"
    },
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "M Motiwala"
    },
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "C Nickele"
    },
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "V Inoa"
    },
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "L Elijovich"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, GA"
      ],
      "name": "J Grossberg"
    },
    {
      "affiliations": [
        "Emory University, Atlanta, GA"
      ],
      "name": "A Alawieh"
    },
    {
      "affiliations": [
        "Semmes-Murphey, Memphis, TN"
      ],
      "name": "N Goyal"
    }
  ],
  "title": "O-016 Balloon-mounted stenting for ICAD after SAMMPRIS: a meta-analysis of contemporary outcomes",
  "uid": "c2a14945-4fa8-583c-bae6-fb1c7c4efc2e"
}