Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion

JACC Cardiovasc Interv. 2014 Oct;7(10):1177-83. doi: 10.1016/j.jcin.2014.05.019. Epub 2014 Sep 17.


Objectives: The aim of this meta-analysis was to evaluate and compare the efficacy of the 2 different neuroprotection systems in preventing embolization during carotid artery stenting (CAS), as detected by diffusion-weighted magnetic resonance imaging (DW-MRI).

Background: Data from randomized and nonrandomized studies comparing both types of embolic protection devices revealed contrasting evidence about their efficacy in neuroprotection, as assessed by the incidence of new ischemic lesions detected by DW-MRI.

Methods: Eight studies, enrolling 357 patients, were included in the meta-analysis. Our study analyzed the incidence of new ischemic lesions/patient, comparing filter cerebral protection and proximal balloon occlusion.

Results: Following CAS, the incidence of new ischemic lesions/patient detected by DW-MRI was significantly lower in the proximal balloon occlusion group (effect size [ES]: -0.43; 95% confidence interval [CI]: -0.84 to -0.02, I(2) = 70.08, Q = 23.40). Furthermore, following CAS, the incidence of lesions at the contralateral site was significantly lower in the proximal protection group (ES: -0.50; 95% CI: -0.72 to -0.27, I(2) = 0.00, Q = 3.80).

Conclusions: Our meta-analysis supports the concept that the use of proximal balloon occlusion compared with filter cerebral protection is associated with a reduction of the amount of CAS-related brain embolization. The data should be confirmed by a randomized clinical trial.

Keywords: carotid artery stenting; cerebral ischemic lesions; diffusion-weighted magnetic resonance imaging; embolic protection device.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Balloon Occlusion*
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / epidemiology
  • Carotid Artery Diseases / therapy*
  • Diffusion Magnetic Resonance Imaging*
  • Embolic Protection Devices*
  • Humans
  • Incidence
  • Intracranial Embolism / diagnosis*
  • Intracranial Embolism / epidemiology
  • Intracranial Embolism / prevention & control*
  • Predictive Value of Tests
  • Prosthesis Design
  • Risk Factors
  • Stents*
  • Time Factors
  • Treatment Outcome