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

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 fr...

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Autores principales: Cho, Young Dae, Kim, Sung-Eun, Lim, Jeong Wook, Choi, Hyuk Jai, Cho, Yong Jun, Jeon, Jin Pyeong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurosurgical Society 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046577/
https://www.ncbi.nlm.nih.gov/pubmed/29631386
http://dx.doi.org/10.3340/jkns.2017.0202.001
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author Cho, Young Dae
Kim, Sung-Eun
Lim, Jeong Wook
Choi, Hyuk Jai
Cho, Yong Jun
Jeon, Jin Pyeong
author_facet Cho, Young Dae
Kim, Sung-Eun
Lim, Jeong Wook
Choi, Hyuk Jai
Cho, Yong Jun
Jeon, Jin Pyeong
author_sort Cho, Young Dae
collection PubMed
description 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.
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spelling pubmed-60465772018-07-16 Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature Cho, Young Dae Kim, Sung-Eun Lim, Jeong Wook Choi, Hyuk Jai Cho, Yong Jun Jeon, Jin Pyeong J Korean Neurosurg Soc Clinical Article 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. Korean Neurosurgical Society 2018-07 2018-04-10 /pmc/articles/PMC6046577/ /pubmed/29631386 http://dx.doi.org/10.3340/jkns.2017.0202.001 Text en Copyright © 2018 The Korean Neurosurgical Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Article
Cho, Young Dae
Kim, Sung-Eun
Lim, Jeong Wook
Choi, Hyuk Jai
Cho, Yong Jun
Jeon, Jin Pyeong
Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title_full Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title_fullStr Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title_full_unstemmed Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title_short Protected versus Unprotected Carotid Artery Stenting : Meta-Analysis of the Current Literature
title_sort protected versus unprotected carotid artery stenting : meta-analysis of the current literature
topic Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046577/
https://www.ncbi.nlm.nih.gov/pubmed/29631386
http://dx.doi.org/10.3340/jkns.2017.0202.001
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