Abstract
The safety and efficacy of standard poststent angioplasty in patients undergoing carotid artery stent placement have not been well-established. We conducted a systematic review of the literature to evaluate the safety and efficacy of carotid artery stent placement and analyzed outcomes of standard-versus-selective poststent angioplasty. A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015. We included studies with >30 patients describing standard or selective poststent angioplasty during carotid artery stent placement. A random-effects meta-analysis was used to pool the following outcomes: periprocedural stroke/TIA, procedure-related neurologic/cardiovascular morbidity/mortality, bradycardia/hypotension, long-term stroke at last follow-up, long-term primary patency, and technical success. We included 87 studies with 19,684 patients with 20,378 carotid artery stenoses. There was no difference in clinical (P = .49) or angiographic outcomes (P = .93) in carotid artery stent placement treatment with selective or standard poststent balloon angioplasty. Both selective and standard poststent angioplasty groups had a very high technical success of >98% and a low procedure-related mortality of 0.9%. There were no significant differences between both groups in the incidence of restenosis (P = .93) or procedure-related complications (P = .37). No comparison to a patient group without poststent dilation could be performed. Our meta-analysis demonstrated no significant difference in angiographic and clinical outcomes among series that performed standard poststent angioplasty and those that performed poststent angioplasty in only select patients.
Highlights
DATA SOURCES: A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015
MATERIALS AND METHODS Study Selection A comprehensive review of the literature was performed by using the keywords “carotid stenosis,” “carotid artery disease,” “revascularization,” “carotid,” “stent,” “angioplasty,” and “endarterectomy” in both “AND” and “OR” combinations to search PubMed, Ovid MEDLINE, Ovid EMBASE, Scopus, and the Web of Science
Four hundred sixtyeight studies were reviewed in additional detail; 283 studies were irrelevant because they lacked information about the use of poststent balloon angioplasty and/or postprocedural outcome/complications of patients
Summary
DATA SOURCES: A systematic search of MEDLINE, EMBASE, Scopus, and the Web of Science was performed for studies published between January 2000 and January 2015. STUDY SELECTION: We included studies with Ͼ30 patients describing standard or selective poststent angioplasty during carotid artery stent placement. DATA ANALYSIS: A random-effects meta-analysis was used to pool the following outcomes: periprocedural stroke/TIA, procedurerelated neurologic/cardiovascular morbidity/mortality, bradycardia/hypotension, long-term stroke at last follow-up, long-term primary patency, and technical success. DATA SYNTHESIS: We included 87 studies with 19,684 patients with 20,378 carotid artery stenoses. There was no difference in clinical (P ϭ .49) or angiographic outcomes (P ϭ .93) in carotid artery stent placement treatment with selective or standard poststent balloon angioplasty. Both selective and standard poststent angioplasty groups had a very high technical success of Ͼ98% and a low procedurerelated mortality of 0.9%. There were no significant differences between both groups in the incidence of restenosis (P ϭ .93) or procedurerelated complications (P ϭ .37)
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