Pavlos Texakalidis1, Alexandros Letsos2, Damianos G Kokkinidis3, Dimitrios Schizas4, Georgios Karaolanis4, Stefanos Giannopoulos4, Spyridon Giannopoulos4, Konstantinos P Economopoulos5, Christos Bakoyannis6. 1. Aristotle University of Thessaloniki, Thessaloniki, Greece; Society of Junior Doctors, Menalou 5 Street, 15123 Athens, Greece. Electronic address: pavlostex.med@gmail.com. 2. University of Crete, Heraklion, Greece; Society of Junior Doctors, Menalou 5 Street, 15123 Athens, Greece. 3. Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Society of Junior Doctors, Menalou 5 Street, 15123 Athens, Greece. 4. 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, 11527 Athens, Greece; Society of Junior Doctors, Menalou 5 Street, 15123 Athens, Greece. 5. Division of Surgery, Duke University School of Medicine; Society of Junior Doctors, Menalou 5 Street, 15123 Athens, Greece. 6. 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, 11527 Athens, Greece.
Abstract
OBJECTIVE: Proximal embolic protection devices (P-EPD) and distal filters (DF) are used to prevent distal cerebral embolizations during carotid artery stenting (CAS). We compared their comparative effectiveness in regards to prevention of intraprocedural and periprocedural adverse events, including ischemic lesions (ipsilateral and contralateral), stroke, transient ischemic attacks (TIA) and death. We also compared the combination of the two neuroprotection strategies vs. a single strategy in regards to ischemic lesions and stroke. MATERIALS & METHODS: This study was performed according to the PRISMA and MOOSE guidelines and eligible studies were identified through search of PubMed, Scopus and Cochrane Central. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity. RESULTS: Twenty-nine studies involving 16,307 patients were included. There was a significant reduction in ischemic lesions with the use of P-EPD among observational studies (RR: 0.66 [0.45-0.97]). There were no statistically significant differences for the other outcomes between the two treatment groups. CONCLUSIONS: There is a number of studies reporting outcomes on the comparison between P-EPD and DF for CAS. P-EDP can reduce distal embolization phenomena resulting into ischemic lesions when compared to DF based on the results from real-world studies. P-EPD was not superior however, in regards to periprocedural stroke, TIA and death. Further studies are anticipated to provide a clear answer to this debate.
OBJECTIVE: Proximal embolic protection devices (P-EPD) and distal filters (DF) are used to prevent distal cerebral embolizations during carotid artery stenting (CAS). We compared their comparative effectiveness in regards to prevention of intraprocedural and periprocedural adverse events, including ischemic lesions (ipsilateral and contralateral), stroke, transient ischemic attacks (TIA) and death. We also compared the combination of the two neuroprotection strategies vs. a single strategy in regards to ischemic lesions and stroke. MATERIALS & METHODS: This study was performed according to the PRISMA and MOOSE guidelines and eligible studies were identified through search of PubMed, Scopus and Cochrane Central. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity. RESULTS: Twenty-nine studies involving 16,307 patients were included. There was a significant reduction in ischemic lesions with the use of P-EPD among observational studies (RR: 0.66 [0.45-0.97]). There were no statistically significant differences for the other outcomes between the two treatment groups. CONCLUSIONS: There is a number of studies reporting outcomes on the comparison between P-EPD and DF for CAS. P-EDP can reduce distal embolization phenomena resulting into ischemic lesions when compared to DF based on the results from real-world studies. P-EPD was not superior however, in regards to periprocedural stroke, TIA and death. Further studies are anticipated to provide a clear answer to this debate.
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