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Distal, proximal embolic protection devices confer similar stroke, mortality protection in CAS
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In patients undergoing carotid artery stenting, distal and proximal embolic protection devices confer comparable protection from periprocedural stroke and death at 30 days, according to recent findings.
In the meta-analysis and review, researchers conducted a comprehensive literature search using various combinations of the search terms “carotid artery stenting,” “carotid stenosis,” “proximal balloon occlusion,” and “distal filter protection.” Eligible studies included trials assessing the use of distal embolic protection devices (D-EPDs) vs. proximal EPDs (P-EPDs) between January 1998 and May 2015. The researchers pooled outcomes across studies using random-effects meta-analysis, and used the I2 statistics to evaluate heterogeneity of treatment effect. Inspection of funnel plots was utilized to evaluate publication bias.
The primary endpoints were 30-day mortality and stroke, and secondary endpoints were new cerebral lesions identified on diffusion-weighted MRI and contralateral lesions identified on diffusion-weighted MRI.
The researchers identified 18 studies (13 prospective, five retrospective; 12,281 patients; mean age, 69 years; 64% men) that compared D-EPD and P-EPD for CAS. There was no indication of publication bias.
A comparison of P-EPD vs. D-EPD in terms of stroke incidence revealed no significant difference between the two strategies in stroke risk (risk difference, 0; 95% CI, –0.01 to 0.01; I2 = 0%). Similarly, no differences were seen between the two modalities in terms of mortality (risk difference, 0; 95% CI, –0.01 to 0.01; I2 = 0%). Moreover, no difference was seen in the secondary endpoints of new lesions on diffusion-weighted MRI (risk difference, 0.1; 95% CI, –0.07 to 0.26; I2 = 0%) or contralateral lesions on diffusion-weighted MRI (I2 = 0%).
In a sensitivity analysis in which the effects of study design were calculated separately, the results did not demonstrate a difference, with P values for subgroup interaction > .05 for all outcomes.
“Our meta-analysis demonstrated no difference in clinical outcomes between D-EPD and P-EPD during CAS. While this finding should reinforce the importance of operator’s comfort and experience with the use of either device, in fact individual patient characteristics may still dictate use of one style of EPD over the other,” the researchers wrote. “Furthermore, emerging data on direct access CAS using P-EPD, double-filtration, meshed-covered stents may change some of these conclusions.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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