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Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis.

Publication ,  Journal Article
Texakalidis, P; Letsos, A; Kokkinidis, DG; Schizas, D; Karaolanis, G; Giannopoulos, S; Giannopoulos, S; Economopoulos, KP; Bakoyannis, C
Published in: Cardiovascular revascularization medicine : including molecular interventions
July 2018

Proximal embolic protection devices (P-EPD) and distal filters (DF) are used to prevent distal cerebral embolizations during carotid artery stenting (CAS). We compared their comparative effectiveness in regards to prevention of intraprocedural and periprocedural adverse events, including ischemic lesions (ipsilateral and contralateral), stroke, transient ischemic attacks (TIA) and death. We also compared the combination of the two neuroprotection strategies vs. a single strategy in regards to ischemic lesions and stroke.This study was performed according to the PRISMA and MOOSE guidelines and eligible studies were identified through search of PubMed, Scopus and Cochrane Central. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity.Twenty-nine studies involving 16,307 patients were included. There was a significant reduction in ischemic lesions with the use of P-EPD among observational studies (RR: 0.66 [0.45-0.97]). There were no statistically significant differences for the other outcomes between the two treatment groups.There is a number of studies reporting outcomes on the comparison between P-EPD and DF for CAS. P-EDP can reduce distal embolization phenomena resulting into ischemic lesions when compared to DF based on the results from real-world studies. P-EPD was not superior however, in regards to periprocedural stroke, TIA and death. Further studies are anticipated to provide a clear answer to this debate.

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Published In

Cardiovascular revascularization medicine : including molecular interventions

DOI

EISSN

1878-0938

ISSN

1553-8389

Publication Date

July 2018

Volume

19

Issue

5 Pt A

Start / End Page

545 / 552

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Stents
  • Risk Factors
  • Protective Factors
  • Middle Aged
  • Male
  • Intracranial Embolism
  • Humans
  • Female
 

Citation

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Texakalidis, P., Letsos, A., Kokkinidis, D. G., Schizas, D., Karaolanis, G., Giannopoulos, S., … Bakoyannis, C. (2018). Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis. Cardiovascular Revascularization Medicine : Including Molecular Interventions, 19(5 Pt A), 545–552. https://doi.org/10.1016/j.carrev.2017.12.010
Texakalidis, Pavlos, Alexandros Letsos, Damianos G. Kokkinidis, Dimitrios Schizas, Georgios Karaolanis, Stefanos Giannopoulos, Spyridon Giannopoulos, Konstantinos P. Economopoulos, and Christos Bakoyannis. “Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis.Cardiovascular Revascularization Medicine : Including Molecular Interventions 19, no. 5 Pt A (July 2018): 545–52. https://doi.org/10.1016/j.carrev.2017.12.010.
Texakalidis P, Letsos A, Kokkinidis DG, Schizas D, Karaolanis G, Giannopoulos S, et al. Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis. Cardiovascular revascularization medicine : including molecular interventions. 2018 Jul;19(5 Pt A):545–52.
Texakalidis, Pavlos, et al. “Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis.Cardiovascular Revascularization Medicine : Including Molecular Interventions, vol. 19, no. 5 Pt A, July 2018, pp. 545–52. Epmc, doi:10.1016/j.carrev.2017.12.010.
Texakalidis P, Letsos A, Kokkinidis DG, Schizas D, Karaolanis G, Giannopoulos S, Economopoulos KP, Bakoyannis C. Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis. Cardiovascular revascularization medicine : including molecular interventions. 2018 Jul;19(5 Pt A):545–552.
Journal cover image

Published In

Cardiovascular revascularization medicine : including molecular interventions

DOI

EISSN

1878-0938

ISSN

1553-8389

Publication Date

July 2018

Volume

19

Issue

5 Pt A

Start / End Page

545 / 552

Related Subject Headings

  • Treatment Outcome
  • Stroke
  • Stents
  • Risk Factors
  • Protective Factors
  • Middle Aged
  • Male
  • Intracranial Embolism
  • Humans
  • Female