@article{3123273,
    title = "Proximal embolic protection versus distal filter protection versus combined protection in carotid artery stenting: A systematic review and meta-analysis",
    author = "Texakalidis, P. and Letsos, A. and Kokkinidis, D.G. and Schizas, D. and Karaolanis, G. and Giannopoulos, S. and Giannopoulos, S. and Economopoulos, K.P. and Bakoyannis, C.",
    journal = "Cardiovascular Revascularization Medicine",
    year = "2018",
    volume = "19",
    number = "5",
    pages = "545-552",
    publisher = "HANLEY & BELFUS-ELSEVIER INC",
    issn = "1553-8389",
    doi = "10.1016/j.carrev.2017.12.010",
    keywords = "artificial embolization;  brain embolism;  brain ischemia;  carotid artery stenting;  cerebrovascular accident;  comparative effectiveness;  death;  diffusion weighted imaging;  human;  meta analysis;  neuroimaging;  neuroprotection;  priority journal;  randomized controlled trial (topic);  Review;  systematic review;  transient ischemic attack;  aged;  brain embolism;  carotid artery disease;  cerebrovascular accident;  complication;  devices;  diagnostic imaging;  embolic protection device;  endovascular surgery;  female;  male;  middle aged;  mortality;  protection;  risk factor;  stent;  treatment outcome;  very elderly, Aged;  Aged, 80 and over;  Carotid Artery Diseases;  Comparative Effectiveness Research;  Embolic Protection Devices;  Endovascular Procedures;  Female;  Humans;  Intracranial Embolism;  Male;  Middle Aged;  Protective Factors;  Risk Factors;  Stents;  Stroke;  Treatment Outcome",
    abstract = "Objective: Proximal embolic protection devices (P-EPD) and distal filters (DF) are used to prevent distal cerebral embolizations during carotid artery stenting (CAS). We compared their comparative effectiveness in regards to prevention of intraprocedural and periprocedural adverse events, including ischemic lesions (ipsilateral and contralateral), stroke, transient ischemic attacks (TIA) and death. We also compared the combination of the two neuroprotection strategies vs. a single strategy in regards to ischemic lesions and stroke. Materials & methods: This study was performed according to the PRISMA and MOOSE guidelines and eligible studies were identified through search of PubMed, Scopus and Cochrane Central. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess for heterogeneity. Results: Twenty-nine studies involving 16,307 patients were included. There was a significant reduction in ischemic lesions with the use of P-EPD among observational studies (RR: 0.66 [0.45–0.97]). There were no statistically significant differences for the other outcomes between the two treatment groups. Conclusions: There is a number of studies reporting outcomes on the comparison between P-EPD and DF for CAS. P-EDP can reduce distal embolization phenomena resulting into ischemic lesions when compared to DF based on the results from real-world studies. P-EPD was not superior however, in regards to periprocedural stroke, TIA and death. Further studies are anticipated to provide a clear answer to this debate. © 2017 Elsevier Inc."
}