Selective-versus-Standard Poststent Dilation for Carotid Artery Disease: A Systematic Review and Meta-Analysis

Area of Science:

• Interventional Cardiology
• Vascular Surgery
• Neurology

Background:

• The established safety and efficacy of standard poststent angioplasty following carotid artery stent placement remain areas requiring further investigation.
• Current evidence does not definitively establish the optimal post-procedural management strategy.

Purpose of the Study:

• To conduct a systematic literature review evaluating the safety and efficacy of carotid artery stent placement.
• To compare outcomes between standard and selective poststent angioplasty techniques.

Main Methods:

• A systematic search of major biomedical databases (MEDLINE, EMBASE, Scopus, Web of Science) was conducted for studies published between January 2000 and January 2015.
• Included studies involved >30 patients and described either standard or selective poststent angioplasty during carotid artery stent placement.
• A random-effects meta-analysis was employed to assess periprocedural stroke/TIA, morbidity/mortality, hemodynamic events, long-term stroke, patency, and technical success.

Main Results:

• The analysis included 87 studies encompassing 19,684 patients and 20,378 carotid artery stenoses.
• No significant differences in clinical (P = .49) or angiographic outcomes (P = .93) were observed between standard and selective poststent angioplasty groups.
• Both approaches demonstrated high technical success rates (>98%) and low procedure-related mortality (0.9%), with no significant differences in restenosis or complications.

Conclusions:

• This meta-analysis indicates that both standard and selective poststent angioplasty yield comparable angiographic and clinical outcomes in carotid artery stent placement.
• Further research is needed to compare these strategies against a control group not receiving poststent dilation.