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A meta‐analysis of proximal occlusion device outcomes in carotid artery stenting
Author(s) -
Bersin Robert M.,
Stabile Eugenio,
Ansel Gary M.,
Clair Daniel G.,
Cremonesi Alberto,
Hopkins L. Nelson,
Nikas Dimitrios,
Reimers Bernhard,
Sievert Horst,
Rubino Paolo
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24433
Subject(s) - medicine , stroke (engine) , myocardial infarction , incidence (geometry) , occlusion , clinical endpoint , adverse effect , carotid stenting , cardiology , meta analysis , surgery , randomized controlled trial , carotid arteries , carotid endarterectomy , mechanical engineering , physics , optics , engineering
Background The clinical risk predictors for adverse events in carotid stenting using distal embolic protection devices are well established and include patient age and symptomatic status. The risk predictors for adverse events with proximal occlusion devices are not as well established. This study is a meta‐analysis of available data on proximal occlusion devices to determine the risk predictors of adverse events in carotid stenting. Methods Study‐specific results on 2,397 patients from six independent databases of two different proximal occlusion devices were meta‐analyzed by an independent statistical analysis organization for predictors of 30‐day major adverse clinical events including stroke, myocardial infarction, and death using random effects models. The primary endpoint was the composite of total stroke, myocardial infarction, and death at 30 days. Results The incidence of stroke was 1.71%. The incidence of myocardial infarction was 0.02%. The incidence of death was 0.40%. The composite primary endpoint at 30 days was 2.25%. Age and diabetic status were found to be the only significant independent risk predictors; however, total stroke rates remained below 2.6% in all subgroups, including symptomatic octogenarians. The other baseline demographic variables including patient gender, symptomatic status, and contralateral carotid occlusion were not found to be independent risk predictors. Conclusions A meta‐analysis of CAS procedures performed with proximal occlusion devices demonstrated a very low incidence of adverse events at 30 days. The only independent risk predictors were age and diabetes. Patient gender, symptomatic status, and other baseline characteristics were not found to be risk predictors for CAS using proximal occlusion devices. © 2012 Wiley Periodicals, Inc.