Self‐expanding versus balloon expandable stent for intracranial arterial stenosis: A systematic review and meta‐analysis

Background and Purpose There are limited data regarding the comparison of balloon expandable stents (BES) and self‐expanding stents (SES) for the treatment of intracranial arterial stenosis. Methods We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023. Statistical pooling with random‐effects meta‐analysis was undertaken to compare the rates/severity of postprocedure stenosis, technical success, 30‐day stroke and/or death, cumulative clinical endpoints, and restenosis rates. Results A total of 20 studies were included. The standardized mean difference (SMD) for postprocedure stenosis (%) was significantly lower (SMD: −0.52, 95% confidence interval [CI]: −0.79 to −0.24, p < .001, 10 studies involving 1515 patients) with BES. The odds for 30‐day stroke and/or death were significantly lower (odds ratio [OR] 0.68, 95% CI: 0.50‐0.94, p = .019, 15 studies involving 2431 patients), and cumulative clinical endpoints on follow‐up were nonsignificantly lower (OR 0.64, 95% CI: 0.30‐1.37, p = .250, 10 studies involving 947 patients) with BES. The odds for restenosis during follow‐up were significantly lower (OR 0.50, 95% CI: 0.31‐0.80, p = .004, 13 studies involving 1115 patients) with BES. Conclusions Compared with SES, BES were associated with lower rates of postprocedure 30‐day stroke and/or death with lower rates of restenosis during follow up and the treatment of symptomatic intracranial arterial stenosis.