Front Neurol. 2026 Sep 30;17:1848611. doi: 10.3389/fneur.2026.1848611. eCollection 2026.
ABSTRACT
BACKGROUND: Medical treatment and endovascular therapy are widely employed in the management of symptomatic intracranial atherosclerotic stenosis, however, the comparative effectiveness of these treatment modalities remains uncertain.
METHODS: We searched major Chinese and English databases to identify randomized controlled trials (RCTs) comparing four different endovascular modalities against other comparable non-endovascular therapies for patients with symptomatic intracranial atherosclerotic stenosis (sICAS). Eligible participants were individuals who had experienced a transient ischemic attack (TIA) or non-disabling stroke within the preceding 12 months. The literature search cutoff date was 11 January 2026.
RESULTS: For safety outcomes, the SUCRA ranking was as follows: medical treatment (MT) (SUCRA 90.1%) > drug-coated balloons (DCB) (SUCRA 52.8%) > balloon dilatation angioplasty (BDA) (SUCRA 40.7%) > bare metal stents (BMS) (SUCRA 35.4%) > drug-eluting stents (DES) (SUCRA 31.0%). MT exhibited a superior safety profile compared with BMS, with a statistically significant difference (RR = 0.47; 95% CI: 0.31 to 0.72). For long-term outcomes, exploratory SUCRA probability rankings were as follows: BDA (SUCRA 86.7%) > DES (SUCRA 77.4%) > MT (SUCRA 23.8%) > BMS (SUCRA 12.1%), and between-treatment differences were not statistically significant across all interventions.
CONCLUSION: In terms of short-term safety, BMS treatment strategies were significantly inferior to medical treatment (MT), while no statistically significant differences in safety were observed among the various endovascular treatment modalities. In terms of adverse events during long-term follow-up, between-treatment differences were not statistically significant. Despite relatively high SUCRA values for BDA and DES for long-term outcomes, these rankings should be interpreted cautiously given the lack of statistically significant inter-group differences. Further research is required to verify the performance of each endovascular treatment strategy about restenosis.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, CRD420251146704.
PMID:42876773 | PMC:PMC13661453 | DOI:10.3389/fneur.2026.1848611