scholarly journals Acute Carotid Artery Stenting Versus Balloon Angioplasty for Tandem Occlusions: A Systematic Review and Meta‐Analysis

2022 ◽  
Author(s):  
Cynthia B. Zevallos ◽  
Mudassir Farooqui ◽  
Darko Quispe‐Orozco ◽  
Alan Mendez‐Ruiz ◽  
Andres Dajles ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Scale Score ◽  
Balloon Angioplasty ◽  
Carotid Artery Stenting ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Modified Rankin Scale ◽  
Retrograde Approach ◽  
Symptomatic Intracranial Hemorrhage

Background Despite thrombectomy having become the standard of care for large‐vessel occlusion strokes, acute endovascular management in tandem occlusions, especially of the cervical internal carotid artery lesion, remains uncertain. We aimed to compare efficacy and safety of acute carotid artery stenting to balloon angioplasty alone on treating the cervical lesion in tandem occlusions. Similarly, we aimed to explore those outcomes’ associations with technique approaches and use of thrombolysis. Methods and Results We performed a systematic review and meta‐analysis to compare functional outcomes (modified Rankin Scale), reperfusion, and symptomatic intracranial hemorrhage and 3‐month mortality. We explored the association of first approach (anterograde/retrograde) and use of thrombolysis with those outcomes as well. Two independent reviewers performed the screening, data extraction, and quality assessment. A random‐effects model was used for analysis. Thirty‐four studies were included in our systematic review and 9 in the meta‐analysis. Acute carotid artery stenting was associated with higher odds of modified Rankin Scale score ≤2 (odds ratio [OR], 1.95 [95% CI, 1.24–3.05]) and successful reperfusion (OR, 1.89 [95% CI, 1.26–2.83]), with no differences in mortality or symptomatic intracranial hemorrhage rates. Moreover, a retrograde approach was significantly associated with modified Rankin Scale score ≤2 (OR, 1.72 [95% CI, 1.05–2.83]), and no differences were found on thrombolysis status. Conclusions Carotid artery stenting and a retrograde approach had higher odds of successful reperfusion and good functional outcomes at 3 months than balloon angioplasty and an anterograde approach, respectively, in patients with tandem occlusions. A randomized controlled trial comparing these techniques with structured antithrombotic regimens and safety outcomes will offer definitive guidance in the optimal management of this complex disease.

Successful mechanical thrombectomy in acute ischemic stroke: revascularization grade and functional independence

2022 ◽  
pp. neurintsurg-2021-018436
Author(s):  
Sherief Ghozy ◽  
Salah Eddine Oussama Kacimi ◽  
Ahmed Y Azzam ◽  
Ramadan Abdelmoez Farahat ◽  
Abdelaziz Abdelaal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Functional Independence ◽  
Complete Revascularization ◽  
Modified Rankin Scale ◽  
Technical Success ◽  
Endovascular Thrombectomy ◽  
Quantitative Synthesis

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

scholarly journals A Systematic Review and Meta-Analysis of Carotid Artery Stenting Using the Trans-Cervical Approach

2020 ◽  
Vol 72 (5) ◽  
pp. 1815
Author(s):  
P.N. Nana ◽  
A.G. Brotis ◽  
K.T. Spanos ◽  
G.N. Kouvelos ◽  
M.I. Matsagkas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Cervical Approach

Carotid Artery Endarterectomy Versus Carotid Artery Stenting for Patients with Contralateral Carotid Occlusion: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 120 ◽  
pp. 563-571.e3 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Damianos G. Kokkinidis ◽  
Theofilos Karasavvidis ◽  
Leonardo Rangel-Castilla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Carotid Occlusion ◽  
Carotid Artery Endarterectomy

scholarly journals Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030025 ◽  
Author(s):  
Yao Feng ◽  
Long Li ◽  
Xuesong Bai ◽  
Tao Wang ◽  
Yanfei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Carotid Artery ◽  
Systematic Reviews ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Primary Data ◽  
Occurrence Rate ◽  
Cochrane Library ◽  
Cerebral Lesions

IntroductionNew ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.Methods and analysisAll relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case–control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and disseminationThere is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.PROSPERO registration numberCRD42019121129

scholarly journals Transcarotid Artery Revascularization Versus Transfemoral Carotid Artery Stenting and Carotid Endarterectomy: A Systematic Review and Meta-analysis

2020 ◽  
Vol 72 (1) ◽  
pp. e208-e209
Author(s):  
Isaac N. Naazie ◽  
Christina Cui ◽  
Osaghae Ikponmwosa ◽  
Mohammad Murad ◽  
Marc L. Schermerhorn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Meta Analysis
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