Objectives: Carotid artery stenting (CAS) is an alternative treatment option for patients at high risk for carotid endarterectomy (CEA) but has been correlated with increased risk for distal embolization and periprocedural stroke despite the use of adjunctive embolic protection devices (EPD). This study compared four types of EPDs and their intra and periprocedural related complications.
Methods: A systematic review of the literature was conducted in PubMed/Medline to identify studies that investigated the outcomes of CAS with adjuvant use of EPDs, including Proximal Balloon (PB), Distal Filter (DF), and Distal Balloon (DB) strategy. Continuous flow reversal performed via transcarotid approach by a commercially available device as an embolic protection strategy was intentionally excluded based on its distinct procedural characteristics and lack of availability outside of the United States. This network meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.
Results: Overall, 45 studies, consisting of 7600 participants satisfied the predetermined search criteria and were included in this network meta-analysis. Overall, 13 studies provided data regarding the number of patients with new ischemic lesions detected in the DW-MRI. DF (OR: 3.15; 95% CI: 1.54-6.44; = 0.002) and DB (OR: 2.28; 95% CI: 1.58-3.29; < 0.001) were associated with higher odds of new ischemic lesions compared to PB on DW-MRI imaging. No statistical difference was identified between DB versus DF groups (OR: 1.48; 95% CI: 0.73-2.59; = 0.317). 36 and 27 studies reported on periprocedural stroke and transient ischemic attack (TIA) rates, respectively, showing similar odds of neurologic adverse events between all three groups.
Conclusions: PB deployment during CAS is superior to DF and DB in preventing distal embolization phenomena. However, no statistically significant difference in TIA and stroke rate was found among any of the analyzed EPD groups. Further research is warranted to investigate the association of embolic phenomena on imaging after CAS with clinically significant neurologic deficits.
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http://dx.doi.org/10.1177/17085381221140616 | DOI Listing |
Expert Rev Cardiovasc Ther
December 2024
Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA.
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Department of Botany and Plant Pathology, Purdue University, West Lafayette, IN, USA.
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View Article and Find Full Text PDFJ Clin Med
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: Acute ischemic stroke is an uncommon but potentially devastating complication of Transcatheter Aortic Valve Implantation (TAVI). Despite improvements in device technology and procedural techniques, stroke rates have remained stable, with cerebral embolic protection devices demonstrating only limited efficacy to date. Therefore, the management of acute ischemic stroke complicating TAVI (AISCT) remains a key priority.
View Article and Find Full Text PDFJ Clin Med
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Collegium Medicum-Faculty of Medicine, WSB University, 41-300 Dabrowa Gornicza, Poland.
Cerebral embolic protection (CEP) during transcatheter aortic valve replacement (TAVR) has emerged as an important tool in reducing stroke risk associated with this intervention. With the recent expansion of TAVR into lower-risk populations, the role of preventive strategies gained greater significance. Despite advancements in TAVR technologies, peri-procedural stroke remains a significant complication, with rates ranging between 2 and 5%.
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