PURPOSE: To compare through a systematic review of published literature the stroke outcomes in protected and unprotected carotid artery stenting (CAS). METHODS: PubMed and Cochrane electronic databases were queried to identify peer-reviewed publications from 1995 to 2007 meeting our pre-defined criteria for inclusion (English language, human only, at least 20 patients reported) and exclusion (procedures performed for the treatment of total occlusion, dissection, or aneurysmal disease; urgently performed procedures; use of covered stents; access other than transfemoral). Information was collected on a standardized data abstraction form for pooled analysis of total strokes within 30 days of procedure in all patients and in symptomatic and asymptomatic subgroups. A random effects meta-analysis of studies with concurrently reported data on protected and unprotected CAS was performed. RESULTS: Initial database query resulted in 2485 articles, of which 134 were included in the final analyses (12,263 protected CAS patients and 11,198 unprotected CAS patients). Twenty-four studies included data on both protected and unprotected CAS. Using pooled analysis of all 134 reports, the relative risk (RR) for stroke was 0.62 (95% CI 0.54 to 0.72) in favor of protected CAS. Subgroup analysis revealed a significant benefit for protected CAS in both symptomatic (RR 0.67; 95% CI 0.52 to 0.56) and asymptomatic (RR 0.61; 95% CI 0.41 to 0.90) patients (p<0.05). Meta-analysis of the 24 studies reporting data on both protected and unprotected stenting demonstrated a relative risk of 0.59 (95% CI 0.47 to 0.73) for stroke, again favoring protected CAS (p<0.001). CONCLUSION: Our systematic review indicated that the use of cerebral protection devices decreased the risk of perioperative stroke with CAS. A well designed randomized trial can further confirm our findings and possibly indicate the device with the best outcomes.
PURPOSE: To compare through a systematic review of published literature the stroke outcomes in protected and unprotected carotid artery stenting (CAS). METHODS: PubMed and Cochrane electronic databases were queried to identify peer-reviewed publications from 1995 to 2007 meeting our pre-defined criteria for inclusion (English language, human only, at least 20 patients reported) and exclusion (procedures performed for the treatment of total occlusion, dissection, or aneurysmal disease; urgently performed procedures; use of covered stents; access other than transfemoral). Information was collected on a standardized data abstraction form for pooled analysis of total strokes within 30 days of procedure in all patients and in symptomatic and asymptomatic subgroups. A random effects meta-analysis of studies with concurrently reported data on protected and unprotected CAS was performed. RESULTS: Initial database query resulted in 2485 articles, of which 134 were included in the final analyses (12,263 protected CASpatients and 11,198 unprotected CASpatients). Twenty-four studies included data on both protected and unprotected CAS. Using pooled analysis of all 134 reports, the relative risk (RR) for stroke was 0.62 (95% CI 0.54 to 0.72) in favor of protected CAS. Subgroup analysis revealed a significant benefit for protected CAS in both symptomatic (RR 0.67; 95% CI 0.52 to 0.56) and asymptomatic (RR 0.61; 95% CI 0.41 to 0.90) patients (p<0.05). Meta-analysis of the 24 studies reporting data on both protected and unprotected stenting demonstrated a relative risk of 0.59 (95% CI 0.47 to 0.73) for stroke, again favoring protected CAS (p<0.001). CONCLUSION: Our systematic review indicated that the use of cerebral protection devices decreased the risk of perioperative stroke with CAS. A well designed randomized trial can further confirm our findings and possibly indicate the device with the best outcomes.
Authors: Stephan Staubach; Ralph Hein-Rothweiler; Matthias Hochadel; Manuela Segerer; Ralf Zahn; Jens Jung; Gotthard Riess; Hubert Seggewiss; Andre Schneider; Thomas Fürste; Christian Gottkehaskamp; Harald Mudra Journal: Clin Res Cardiol Date: 2012-05-30 Impact factor: 5.460
Authors: R Oteros; E Jimenez-Gomez; F Bravo-Rodriguez; J J Ochoa; R Guerrero; F Delgado Journal: AJNR Am J Neuroradiol Date: 2012-03-15 Impact factor: 3.825
Authors: Verónica Fernández-Alvarez; Fernando López; Carlos Suárez; Primoz Strojan; Avraham Eisbruch; Carl E Silver; William M Mendenhall; Johannes A Langendijk; Alessandra Rinaldo; Anne W M Lee; Jonathan J Beitler; Robert Smee; Javier Alvarez; Alfio Ferlito Journal: Strahlenther Onkol Date: 2018-04-20 Impact factor: 3.621
Authors: Katie E Shean; John C McCallum; Peter A Soden; Sarah E Deery; Joseph R Schneider; Brian W Nolan; Caron B Rockman; Marc L Schermerhorn Journal: J Vasc Surg Date: 2017-03-27 Impact factor: 4.268
Authors: Marc W K Tietke; Tina Kerby; Karsten Alfke; Christian Riedel; Axel Rohr; Ulf Jensen; Phillip Zimmermann; Robert Stingele; Olaf Jansen Journal: Neuroradiology Date: 2010-03-23 Impact factor: 2.804
Authors: P Nazari; P Golnari; M C Hurley; A Shaibani; S A Ansari; M B Potts; B S Jahromi Journal: AJNR Am J Neuroradiol Date: 2021-04-01 Impact factor: 4.966