Assessment of short-term outcomes for protected carotid angioplasty with stents using recent evidence

Carotid artery stenosis is an important risk factor and etiology of stroke. Carotid endarterectomy (CEA) is the gold standard for the treatment of carotid artery stenosis; however, there are potential benefits to adopting the use of carotid artery stenting (CAS) with protection devices. A number of large protected CAS (PCAS) trials are underway, but final results are still several years away. In the interim, numerous PCAS studies have recently been published, and the aim of this study was to combine the published results and examine the outcomes and safety of PCAS. Electronic, manual, and bibliographic searches of PubMed and PreMedline were conducted. Proportion differences were calculated for the periprocedural (30-day) outcomes of any stroke and any stroke or death. More than 400 articles were identified. Only 26 studies met the inclusion criteria, resulting in the inclusion of 2,992 patients treated with PCAS. Within this patient group, the pooled perioperative PCAS rate of any type of stroke was 2.4% ± 0.3% (95% confidence interval [CI]). The 30-day minor stroke rate was 1.1% ± 0.2% (95% CI), and the 30-day major stroke rate was 0.6% ± 0.2% (95% CI). The 30-day mortality rate was 0.9% ± 0.4% (95% CI). This study demonstrates relatively low rates of reported perioperative adverse events in PCAS. Selective use of PCAS to treat carotid artery stenosis in those at highest risk for surgical complications is appropriate until the randomized trials of CEA vs PCAS provide concurrent short- and long-term outcome data.