J Korean Neurosurg Soc.  2018 Jul;61(4):458-466. 10.3340/jkns.2017.0202.001.

Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature

• Cho YD
• Kim SE
• Lim JW
• Choi HJ
• Cho YJ
• Jeon JP

• KMID: 2417321
• DOI: http://doi.org/10.3340/jkns.2017.0202.001

Abstract

OBJECTIVE
To compare peri-operative any symptomatic stroke after carotid angioplasty and stenting (CAS), based on the application or absence of a cerebral protection device.
METHODS
A systematic literature review using PubMed, Embase, and the Cochrane Central was done across an online data base from January 1995 to October 2016. Procedures which were performed due to carotid dissection or aneurysm, procedures using covered stents or conducted in an emergency, were excluded. The primary endpoint was perioperative any symptomatic stroke within 30 days after the procedure. A fixed effect model was used in cases of heterogeneity less than 50%.
RESULTS
In the 25 articles included in this study, the number of stroke events was 326 (2.0%) in protected CAS and 142 (3.4%) in unprotected CAS. The use of cerebral protection device significantly decreased stroke after CAS (odds ratio [OR] 0.633, 95% confidence interval [CI] 0.479-0.837, p=0.001). In the publication bias analysis, Egger's regression test disclosed that the intercept was -0.317 (95% CI -1.015-0.382, p=0.358). Regarding symptomatic patients (four studies, 539 CAS procedures), the number of stroke was six (1.7%) in protected CAS and 11 (5.7%) in unprotected CAS. The protective effect against stroke events by cerebral protection device did not have a statistical significance (OR 0.455, 95% CI 0.151-1.366, p=0.160).
CONCLUSION
The use of protection device significantly decreased stroke after CAS. However, its efficacy was not demonstrated in symptomatic patients. Routine use of protection device during CAS should be critically assessed before mandatory use.

Keyword

Carotid artery stenosis; Stents; Meta-analysis

MeSH Terms

Aneurysm
Angioplasty
Carotid Arteries*
Carotid Stenosis
Emergencies
Humans
Population Characteristics
Publication Bias
Stents*
Stroke

Figure

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  Fig. 1. Flow diagram for identification of relevant studies.

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  Fig. 2. A : Perioperative stroke events between protected and unprotected carotid angioplasty and stenting. B : Funnel plots for publication bias in perioperative stroke in all studies. CI : confidence interval.

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  Fig. 3. A : Perioperative stroke between protected and unprotected carotid angioplasty and stenting in patients with symptomatic carotid stenosis. B : Funnel plots for publication bias in perioperative stroke in patients with symptomatic carotid stenosis. CI : confidence interval.

Reference

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