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Drug-Eluting Stent Versus Bare Metal Stent for Symptomatic Intracranial Stenosis: A Comparative Systematic Review and Meta-Analysis Study Publisher



Mirjani MS1 ; Delbari P2 ; Ahmadvand MH2 ; Sabet S2 ; Ardestani Z2 ; Sharifi ME3 ; Hatami S4 ; Jabari M5 ; Barkhordarioon A2 ; Akbari Javar MT4 ; Bahri A6 ; Ahmadi S7 ; Hajikarimloo B8 ; Mohammadzadeh I9 Show All Authors
Authors
  1. Mirjani MS1
  2. Delbari P2
  3. Ahmadvand MH2
  4. Sabet S2
  5. Ardestani Z2
  6. Sharifi ME3
  7. Hatami S4
  8. Jabari M5
  9. Barkhordarioon A2
  10. Akbari Javar MT4
  11. Bahri A6
  12. Ahmadi S7
  13. Hajikarimloo B8
  14. Mohammadzadeh I9
  15. Habibi MA10
  16. Saber H11
Show Affiliations
Authors Affiliations
  1. 1. Student Research Committee, Qom University of Medical Sciences, Qom, Iran
  2. 2. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Neuroscience Researcher, Shariati Hospital Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
  5. 5. Medical Campus, Xi’an Jiaotong University, Shaanxi Province, Xi’an, China
  6. 6. Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Case Western Reserve University, Cleveland, OH, United States
  8. 8. Department of Neurological Surgery, University of Virginia, Charlottesville, United States
  9. 9. Skull Base Research Center, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  10. 10. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  11. 11. Departments of Neurology and Neurosurgery, Dell Medical School at UT Austin, Austin, TX, United States

Source: European Journal of Clinical Pharmacology Published:2025


Abstract

Background: Intracranial atherosclerotic artery stenosis (ICAS) is a major cause of ischemic stroke globally and is associated with poor recanalization rates, high recurrence, and adverse functional outcomes. The use of stents has been explored as a treatment option to improve outcomes, despite concerns over procedure-related complications and in-stent restenosis (ISR). This study aimed to compare the efficacy and safety of drug-eluting stents (DES) versus bare metal stents (BMS) in treating patients with symptomatic ICAS (sICAS). Method: A systematic review and meta-analysis were conducted according to PRISMA guidelines, with a comprehensive search of PubMed, Embase, and Web of Science up to March 1, 2024. Studies that reported outcomes such as technical and clinical success rates, periprocedural complications, ISR, and stroke rates were included. Statistical analysis was performed using Stata v.17. Results: A total of 44 studies involving 13,658 patients were included. DES demonstrated lower pooled rates of major stroke (3% [95% CI 2–4%]) and ISR (8% [95% CI 3–12%]) compared to BMS (5% [95% CI 3–6%] for major stroke and 19% [95% CI 14–24%] for ISR), though the difference in major stroke rate was not statistically significant. The clinical success rate was similar between DES (89% [95% CI 78–99%]) and BMS (86% [95% CI 76–97%]). Technical success rates were high and comparable for both stent types. Subgroup analyses and meta-regression identified significant factors influencing heterogeneity, including stent or wire length and diameter. Conclusion: DES showed a significant advantage over BMS in reducing ISR and major stroke rates while maintaining comparable safety and technical success. These findings support the preferential use of DES in clinical practice for managing sICAS, emphasizing their role in enhancing patient outcomes through reduced restenosis and recurrent ischemic events. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.
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