{
  "abstract": "Background The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) relative to medical management in treating symptomatic intracranial arterial stenosis (ICAS) varies based on the qualifying artery. This study aims to evaluate PTAS compared with medical therapy alone in cases of ICAS involving the internal carotid artery (ICA), middle cerebral artery (MCA), vertebral artery (VA) and basilar artery (BA).Methods This study involves a thorough pooled analysis of individual patient data from two randomised controlled trials, evaluating the efficacy of PTAS in comparison to medical management for symptomatic ICAS with different qualifying arteries. The primary outcome was stroke or death within 30 days postenrolment, or stroke in the region of the qualifying artery beyond 30 days through 1 year. A methodology based on intention-to-treat was employed, and HR accompanied by 95% CIs were used to convey risk estimates.Results The data of 809 individuals were collected from Stenting vs Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial and China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis trial. Four hundred were designated for PTAS, while 409 were assigned to medical therapy alone. For the primary outcome, patients with symptomatic BA stenosis had a significantly higher risk of receiving PTAS compared with medical therapy (17.17% vs 7.77%; 9.40; HR, 2.38 (1.03 to 5.52); p=0.04). However, PTAS had no significant difference in patients with symptomatic ICA (26.67% vs 16.67%; HR, 1.68 (0.78 to 3.62); p=0.19), MCA (8.28% vs 9.79%; HR, 0.85 (0.42 to 1.74); p=0.66) and VA stenosis (9.52% vs 10.71%; HR, 0.91 (0.32 to 2.62); p=0.86) compared with medical therapy.Conclusions PTAS significantly increases the risk of both short-term and long-term stroke in patients with symptomatic BA stenosis. Without significant technological advancements to mitigate these risks, PTAS offers limited benefits. For symptomatic ICA, MCA and VA stenosis, PTAS provided no significant advantage.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Tianhua Li"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Jichang Luo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Xuesong Bai"
    },
    {
      "affiliations": [
        "Neuro Interventional Surgery, Medical University of South Carolina, Charleston, South Carolina, USA"
      ],
      "name": "Eyad Almallouhi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China",
        "Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Peng Gao"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Delin Liu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Ran Xu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Wenlong Xu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Guangdong Lu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Haozhi Gong"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Xiao Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Taoyuan Lu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Jie Wang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Renjie Yang"
    },
    {
      "affiliations": [
        "Health Science Center, Xian Jiaotong University, Xi'an, Shaanxi, China"
      ],
      "name": "Zixuan Xing"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Guangjie Liu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China"
      ],
      "name": "Yufu Dai"
    },
    {
      "affiliations": [
        "Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA"
      ],
      "name": "Colin P Derdeyn"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China",
        "Department of Neurosurgery and Neurology, Jinan Hospital of Xuanwu Hospital, Jinan, China"
      ],
      "name": "Liqun Jiao"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China",
        "Department of Neurosurgery and Neurology, Jinan Hospital of Xuanwu Hospital, Jinan, China"
      ],
      "name": "Tao Wang"
    }
  ],
  "title": "Stenting for symptomatic intracranial arterial stenosis with different qualifying arteries: a preplanned pooled individual patient data analysis",
  "uid": "2ed99211-fbec-5bc6-bd0d-365e4a545c9a"
}