Clinical Research
Peripheral
Cerebral Embolic Lesions Detected With Diffusion-Weighted Magnetic Resonance Imaging Following Carotid Artery Stenting: A Meta-Analysis of 8 Studies Comparing Filter Cerebral Protection and Proximal Balloon Occlusion

https://doi.org/10.1016/j.jcin.2014.05.019Get rights and content
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Abstract

Objectives

The aim of this meta-analysis was to evaluate and compare the efficacy of the 2 different neuroprotection systems in preventing embolization during carotid artery stenting (CAS), as detected by diffusion-weighted magnetic resonance imaging (DW-MRI).

Background

Data from randomized and nonrandomized studies comparing both types of embolic protection devices revealed contrasting evidence about their efficacy in neuroprotection, as assessed by the incidence of new ischemic lesions detected by DW-MRI.

Methods

Eight studies, enrolling 357 patients, were included in the meta-analysis. Our study analyzed the incidence of new ischemic lesions/patient, comparing filter cerebral protection and proximal balloon occlusion.

Results

Following CAS, the incidence of new ischemic lesions/patient detected by DW-MRI was significantly lower in the proximal balloon occlusion group (effect size [ES]: −0.43; 95% confidence interval [CI]: −0.84 to −0.02, I2 = 70.08, Q = 23.40). Furthermore, following CAS, the incidence of lesions at the contralateral site was significantly lower in the proximal protection group (ES: −0.50; 95% CI: −0.72 to −0.27, I2 = 0.00, Q = 3.80).

Conclusions

Our meta-analysis supports the concept that the use of proximal balloon occlusion compared with filter cerebral protection is associated with a reduction of the amount of CAS-related brain embolization. The data should be confirmed by a randomized clinical trial.

Key Words

carotid artery stenting
cerebral ischemic lesions
diffusion-weighted magnetic resonance imaging
embolic protection device

Abbreviations and Acronyms

CAS
carotid artery stenting
CI
confidence interval
DW-MRI
diffusion-weighted magnetic resonance imaging
EPD
embolic protection device
ES
effect size

Cited by (0)

The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 2 authors contributed equally to this work.