Next-generation Onyx DES for elective intracranial atherosclerosis: A meta-analysis.
Toka Adel Hassan, Ahar Bhatt, Fadar Oliver Otite et al.
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In 30 seconds
This PRISMA-guided meta-analysis pooled evidence from four studies involving 314 adults with symptomatic intracranial atherosclerotic disease treated electively with Onyx drug-eluting balloon-mounted stents. Random-effects models were used to estimate event rates. Periprocedural complications were reported in 1.0% of patients, and the 30-day complication rate was 5%. Events including stroke, transient ischemic attack, and in-stent restenosis increased during follow-up, reaching 9% at six months and persisting through one year. The authors describe the findings as promising but call for larger prospective studies to establish longer-term safety and efficacy.
Key findings
- Periprocedural complications occurred in 1.0% of patients, including one hemorrhagic stroke and one fatal aneurysm rupture.
- The 30-day complication rate was 5%, involving strokes, deaths, and transient ischemic attacks.
- Follow-up events, including strokes, transient ischemic attacks, and in-stent restenosis, reached 9% at six months and persisted through one year.
Why it matters
The pooled findings provide an early overview of outcomes with Onyx drug-eluting stents for symptomatic intracranial atherosclerotic disease. Although early complication rates were low in these studies, later events underscore the importance of assessing outcomes beyond the procedure and initial 30 days. The evidence remains insufficient to establish durable safety or efficacy.
What to keep in mind
The analysis included only four studies and 314 patients; the authors state that larger prospective studies are needed to confirm the findings and assess long-term outcomes.