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Cerebral protection devices for use during carotid artery stenting
Insights
Cerebral protection devices (CPDs) do not significantly reduce stroke risk during carotid angioplasty with stenting (CAS). CPDs are safe, but evidence is lacking for asymptomatic patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid angioplasty with stenting (CAS) is an alternative to endarterectomy for carotid artery disease.
- Cerebral protection devices (CPDs) aim to reduce stroke and death during CAS.
- The efficacy of CPDs compared to CAS without protection and endarterectomy is under investigation.
Purpose of the Study:
- To evaluate the effectiveness of CPDs in reducing stroke and death during CAS.
- To compare outcomes of CAS with CPDs versus CAS without CPDs and endarterectomy.
- To assess the safety and complication profile of CPDs.
Main Methods:
- Systematic review and meta-analysis of nine studies.
- Comparison of procedural stroke and death rates.
- Inclusion of studies comparing CAS with and without CPDs, and endarterectomy.
Main Results:
- No statistically significant difference in stroke or death rates between CAS with CPDs, CAS without CPDs, and endarterectomy.
- Complications associated with CPDs were minor and transient.
- CAS with CPDs may be safe and effective for symptomatic, high-risk patients.
Conclusions:
- CPDs do not significantly alter stroke or death rates in CAS.
- CPDs are safe, with minor complications.
- Evidence is insufficient to support CPD use in asymptomatic patients undergoing CAS.
Abstract:
(1) Cerebral protection devices offer a new approach to reducing the risk of stroke and death in patients undergoing carotid angioplasty with stenting (CAS). (2) Nine studies have examined the efficacy of cerebral protection devices, by comparing the incidence of procedure related stroke and death to that of CAS without protection, and to surgical endarterectomy. Few of the studies were of high quality. (3) Overall, the differences in the incidence of procedure-related stroke and death were not statistically significant among patients who underwent CAS without protection, compared to those who received CAS with protection, or to those who underwent endarterectomy. (4) Complications reported with the use of cerebral protection devices are minor and transient. (5) CAS with cerebral protection may offer a safe and efficacious alternative to endartectomy in symptomatic, high risk patients with severe carotid artery disease. Evidence to support the use of CAS with cerebral protection devices in asymptomatic patients who have severe carotid artery stenosis, is unavailable.
