Intracranial artery atherosclerotic stenosis (ICAS) is a major cause of stroke, especially in Asian countries. Current treatment options, including balloon-mounted stent (BMS) and balloon angioplasty (BA), lack sufficient evidence to determine a preferred approach. This systematic review and meta-analysis aimed to compare the efficacy and safety of BMS and BA in treating ICAS. Following PRISMA 2020 guidelines, we conducted a comprehensive search in PubMed, Web of Science, and Scopus up to December 1, 2023. Eligible studies compared BMS with BA in patients diagnosed with ICAS. Primary outcomes included the success rate and occurrence of stroke (ischemic or hemorrhagic). Secondary outcomes were perforator occlusion, in-stent thrombosis, death, and restenosis. Statistical analysis was conducted using R software version 4.3.1, employing a random-effects model. Five high-quality studies involving 707 patients (515 males, 192 females) were included. BMS had a significantly higher success rate compared to BA (Risk Ratio [RR]: 1.13; CI: 1.03 to 1.24, p<0.01; I=14%). The overall risk for stroke (ischemic and hemorrhagic) was significantly higher in BMS (RR: 2.97; CI: 1.32 to 6.67, p<0.01; I=0%). However, no significant difference was found between BMS and BA regarding ischemic stroke (RR: 2.33; CI: 0.80 to 6.74, p=0.12; I=0%). Additionally, no significant differences were observed in terms of perforator occlusion, in-stent thrombosis, dissection, minor and major strokes, and mortality rates. BMS was associated with a lower risk of restenosis (RR: 0.31; 95% CI: 0.12 to 0.83, p=0.02; I=0%). Our results indicate that BMS might be associated with higher success and lower restenosis rates than BA in the treatment of ICAS but with an increased overall risk of stroke. No significant differences were observed in ischemic stroke, perforator occlusion, in-stent thrombosis, dissection, minor and major strokes, and mortality rates. The choice of treatment should consider these findings, alongside the technical challenges and desired angiographic outcomes. Future randomized controlled trials are necessary to further elucidate these results.

中文翻译：

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球囊支架与球囊血管成形术治疗颅内动脉狭窄：系统评价和荟萃分析

颅内动脉粥样硬化性狭窄（ICAS）是中风的主要原因，尤其是在亚洲国家。目前的治疗方案，包括球囊支架 (BMS) 和球囊血管成形术 (BA)，缺乏足够的证据来确定首选方法。本系统评价和荟萃分析旨在比较 BMS 和 BA 治疗 ICAS 的有效性和安全性。根据 PRISMA 2020 指南，我们在 PubMed、Web of Science 和 Scopus 中进行了截至 2023 年 12 月 1 日的全面检索。符合条件的研究对诊断为 ICAS 的患者进行了 BMS 与 BA 的比较。主要结局包括成功率和中风（缺血性或出血性）的发生率。次要结局是穿支闭塞、支架内血栓形成、死亡和再狭窄。使用 R 软件版本 4.3.1 进行统计分析，采用随机效应模型。纳入了五项高质量研究，涉及 707 名患者（515 名男性，192 名女性）。与 BA 相比，BMS 的成功率显着更高（风险比 [RR]：1.13；CI：1.03 至 1.24，p<0.01；I=14%）。BMS 中风（缺血性和出血性）的总体风险显着较高（RR：2.97；CI：1.32 至 6.67，p<0.01；I=0%）。然而，BMS 和 BA 在缺血性卒中方面没有发现显着差异（RR：2.33；CI：0.80 至 6.74，p=0.12；I=0%）。此外，在穿支闭塞、支架内血栓形成、夹层、轻微和严重中风以及死亡率方面没有观察到显着差异。BMS 与较低的再狭窄风险相关（RR：0.31；95% CI：0.12 至 0.83，p=0.02；I=0%）。我们的结果表明，在 ICAS 治疗中，BMS 可能比 BA 具有更高的成功率和更低的再狭窄率，但会增加中风的总体风险。在缺血性卒中、穿支闭塞、支架内血栓形成、夹层、轻微和严重卒中以及死亡率方面没有观察到显着差异。治疗的选择应考虑这些发现以及技术挑战和期望的血管造影结果。未来有必要进行随机对照试验来进一步阐明这些结果。