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

Abstract

ObjectiveTo compare peri-operative any symptomatic stroke after carotid angioplasty and stenting (CAS), based on the application or absence of a cerebral protection device.MethodsA 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%.ResultsIn 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).ConclusionThe 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.

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

“…The Trim-and-Fill method was performed further to estimate the number and outcome of missing studies. [14][15][16] The comprehensive meta-analysis (CMA) software (CMA v2.2.064; Biostat, Englewood, NJ, USA) was used for all the above, with statistical significance defined as P<0.05.…”

“…Two recent randomized controlled trials (RCTs) 2 revealed no association between anesthesia type and clinical outcomes. Löwhagen Hendén et al 2 reported no differences in early neurologic improvement (NIHSS score shift within 24 hours after intervention, 9 [4][5][6][7][8][9][10][11][12][13][14][15][16][17] in GA vs. 8 [2.5-13] in CS; P=0.272) and good outcomes at 3 months (n=19, 42.2% in GA vs. 18, 40.0% in CS; P=1.00). Schönenberger et al 5 also reported no neurologic improvement according to anesthesia type in acute anterior circulation stroke after thrombectomy.…”

Genome-wide blood DNA methylation analysis in patients with delayed cerebral ischemia after subarachnoid hemorrhage

“…The derivation cohort was obtained from the stroke database of the Chuncheon Sacred Heart Hospital. The cohort is a prospective and observational project in the regional center of the district of Chuncheon city, the capital city of Gangwon Province in Korea 11 , 29 – 31 . In this database, we enrolled SAH patients with the following conditions: (1) adult SAH patients aged above 18 years; and (2) SAH due to ruptured aneurysm associated with saccular appearance.…”

A Preliminary Study of the Association between <i>SOX17</i> Gene Variants and Intracranial Aneurysms Using Exome Sequencing

“…The exclusion criteria were 1) fusiform, dissected, traumatic or infectious aneurysms and 2) patients with concomitant other cerebrovascular diseases. Patients who met the following criteria were selected as controls : 1) patients who underwent radiologic tests for headache or medical check-ups with 2) no familial history of IA or SAH among the first-degree relatives [ 6 , 9 , 12 , 13 , 18 ].…”