| Backround:Intracranial atherosclerotic disease(ICAD)is widely known by people recent years because of the development of the neuroimaging.Doctors can get the imaging of intracranial arteries by noninvasive techniques.Recently ICAD has been suggested to be the most common cause of ischemia stroke worldwide,and more and more researchers have paid attention to ICAD.It is well described that patients of Asian,African,and Hispanic ancestry are at higher risk of ICAD.Age,diabetes mellitus,hypertension and hyperlipidemia are identified as independent risk factors for ICAD.It is mainly diagnosed by neuroimaging and the aggressive medical management is the main treatment.Percutaneous transluminal angioplasty and stenting(PTAS)has increasingly been used in clinical practice all around the world.Several studies compared the effective and safty of PTAS with medicine theropy alone.It is necessary to compare the immediate and long term outcomes between PTAS plus medical therapy and medical therapy alone for ICAD.In traditional Chinese medicine there was no record about ICAD,but traditional Chinese herbal has been use in patients with ICAD.Several studies shown compared with the western medicine alone,integrated of traditional and western medicine has a good effect for ICAD.Against the background of an increasing amount of data on those fields,we systematically searched the relevant studies,which compared the effective and safety between PTAS and medical therapy alone and between integrated medicine and western medicine for ICAD.Methods:We searched China National Knowledge Infrastructure,Wan-Fang Database,Chinese Scientific Journal Database,Chinese Biomedical Literature Database,PubMed and EMBASE for studies compared the effective and safety between integrated medicine and western medicine for ICAD up to 31 December 2017.According to the inclusion criteria and exclusion criteria which were developed before,we review the studies.Data of recurrent stroke,death,intracranial hemorrhage,myocardial infarction,modified Rankin scale,blood flow rate of cerebral artery,and rate of cerebral artery peak value of systole in 7 days,90 days and 1 year follow-up were collected.Statistical analysis was performed using Review Manager Version 5.3 software(Cochrane Collaboration,Oxford,UK).Results:1.PTAS vs medical therapy alone for ICAD.Three studies involving 581 cases were included.The meta-analysis indicated that any stroke in 30 days follow-up(RR=3.13;95%CI:1.94-26.77)and intracranial hemorrhage during the follow-up(RR = 7.20;95%CI:1.96-110.48)medical therapy alone were lower compared with PTAS plusmedical therapy,but there were no significant differences in any death and myocardial infarction between the two groups.2.Integrated medicine vs western medicine for ICAD.3 studies were identified,and the atherosclerotic lesions were all located in middle cerebral arteries.Stroke and syndrome differentiation and syndrome treatment system,tanyuzuluo formal,banxiabaizhu capsule were used in the 3 studies.All the 3 studies had high risk of selection bias,performance bias and detection bias.Data in the 3 studies shown compared integrated medicine with western medicine there were significant differences in recurrent stroke,modified Rankin scale,blood flow rate of cerebral artery and rate of cerebral artery peak value of systole.Conclusion:PTAS had a higer rate of perioperative stroke and intracranial hemorrhage,but for long term outcomes there were no different between the two groups.Patients who are failed in medical tharepy PTAS is a good choice.Integrated medicine had a lower rate of recurrent stroke,slower blood flow rate,better outcome compared with western medicine.But the studies in our systematic review had high risk of bias which mean the conclusion was unreliable.In the future,more quality clinical trials are needed to reappraise the effect of integrated medicine for ICAD. |
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