Proximal occlusion versus distal filter for cerebral protection during carotid stenting: updated meta-analysis of randomised and observational MRI studies

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Salvatore CasseseMassimiliano Fusaro

Abstract

Proximal occlusion (PO) and distal filter (DF) serve for cerebral embolic protection during carotid artery stenting (CAS). New cerebral lesions at diffusion-weighted magnetic resonance imaging (DW-MRI) represent a surrogate endpoint for embolisation, though their clinical impact is controversial. We performed a meta-analysis of randomised and observational DW-MRI studies comparing PO and DF during CAS. We searched electronic scientific databases. The primary endpoint was the incidence of new cerebral lesions at DW-MRI; secondary endpoints were the incidence of new ipsilateral and new contralateral cerebral lesions at DW-MRI and death/cerebrovascular events (CVE). A total of 392 patients (seven studies) received CAS. At DW-MRI after 48 hours 178 patients (48.3%) presented new cerebral lesions. The use of PO versus DF reduced neither the risk of new cerebral lesions (OR [95% confidence interval] 0.65 [0.28-1.52], p=0.32) nor the risk of death/CVE (0.59 [0.22-1.60], p=0.30). Diabetes, baseline stenosis and symptoms significantly modified the risk estimates for new cerebral lesions. In this meta-analysis, one half of patients receiving protected CAS developed new embolic cerebral lesions at DW-MRI, although the overwhelming majorit...Continue Reading

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Citations

Feb 13, 2016·Journal of Interventional Cardiology·Derek C WhiteTheodore L Schreiber
Apr 12, 2015·International Journal of Cardiology·Giuseppe GargiuloGiovanni Esposito
Jun 21, 2018·Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists·Pavlos TexakalidisGiuseppe Lanzino
Nov 1, 2018·European Radiology·Giuseppe Biondi-ZoccaiFrancesco Versaci
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Jun 18, 2017·Clinical Neuroradiology·Joachim BerkefeldRichard du Mesnil
May 4, 2017·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Jad OmranChristopher J White

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