ABSTRACT NUMBER: ESOC2026A1869 ENDOVASCULAR THERAPY FOR SYMPTOMATIC INTRACRANIAL STENOSIS: AN UPDATED META-ANALYSIS OF EARLY SAFETY OUTCOMES OF 1,967 PATIENTS

Abstract Background and aims Endovascular approaches (angioplasty or stenting, including balloon-based interventions) are used for symptomatic intracranial atherosclerotic stenosis, but concerns persist regarding early safety compared with medical therapy alone. We aim to compare early safety outcomes between endovascular therapy and medical management in patients with symptomatic intracranial atherosclerotic stenosis. Methods We conducted an updated systematic review and meta-analysis and pooled all studies evaluating endovascular therapy versus medical management. Random-effects models pooled risk ratios (RRs) for early safety outcomes; statistical heterogeneity was summarized using I2. Results Endovascular therapy was associated with higher risk of any ischemic stroke within 30 days (RR 1.85, 95% CI 1.10–3.12; I2=0%; 5 studies), intracranial hemorrhage (RR 5.53, 95% CI 2.25–13.60; I2=0%; 8 studies), and stroke or death within 30 days (RR 2.26, 95% CI 1.45–3.53; I2=0%; 6 studies). All-cause death within 30 days did not show a clear difference (RR 1.80, 95% CI 0.53–6.12; I2=10.07%; 6 studies). Conclusions Compared with medical therapy alone, endovascular therapy was associated with increased early risks of ischemic stroke, intracranial hemorrhage, and the composite of stroke or death, without a clear difference in short-term all-cause mortality. These findings emphasize careful patient selection and strategies to reduce periprocedural complications when considering endovascular intervention. Conflict of interest All Authors have nothing to disclose Figure 1 - belongs to Results