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

The clinical efficacy of endovascular recanalisation in patients with non-acute intracranial arterial occlusion (NAICAO) remains controversial. We conducted a systematic search in three databases PubMed, EMBASE, and Web of science core for endovascular recanalisation for the treatment of NAICAO series cases according to PRISMA guidelines. Twenty-three articles with 1571 patients were included, with 1529 undergoing endovascular recanalisation and 42 receiving conservative drug therapy alone. The overall success rate of endovascular recanalisation was 87% (95% CI: 0.84-0.91, I 2 =78%); the rate of periprocedural complications was 13% (95% CI: 0.10-0.15, I 2 =48%); the periprocedural mortality rate was 0% (95% CI: 0.00-0.01, I 2 =0%); and imaging follow-up in patients with successful recanalisation showed that overall restenosis and reocclusion rate were 15% (95% CI: 0.13-0.18, I 2 =17%); long-term follow-up stroke recurrence and mortality in the successful recanalisation group were 7% (95% CI: 0.04-0.09, I 2 =67%); and in long-term follow-up stroke recurrence and mortality were significantly lower in the successful recanalisation group than in the failure to recanalise group (OR: 0.15, 95% CI: 0.06-0.37, I 2 =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, I 2 =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, I 2 =0%, P=0.48). In NAICAO, endovascular recanalisation presents a good safety and efficacy. Endovascular recanalisation could be another option for patients with NAICAO ineffective on medical treatment.