Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis

2.50
Hdl Handle:
http://hdl.handle.net/10757/622326
Title:
Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis
Authors:
Cho, Sung-Min; Deshpande, Abhishek; Pasupuleti, Vinay; Hernandez, Adrian V. ( 0000-0002-9999-4003 ) ; Uchino, Ken
Citation:
Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis. 2017 Neurology
Publisher:
American Academic of Neurology
Journal:
Neurology
Issue Date:
11-Oct-2017
URI:
http://hdl.handle.net/10757/622326
DOI:
10.1212/WNL.0000000000004626
PubMed ID:
29021357
Additional Links:
https://www.ncbi.nlm.nih.gov/pubmed/?term=29021357%5Buid%5D
Abstract:
OBJECTIVE: In a systematic review, we compared ratio of new periprocedural radiographic brain ischemia (RBI) to the number of strokes and TIAs among patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS: We searched 5 databases for entries related to brain ischemia in CEA or CAS from inception through September 2015. We included articles with CEA or CAS and systematic performance of preprocedural and postprocedural brain MRI and reporting of RBI and stroke incidence. We calculated a symptomatic risk ratio of number of strokes and TIAs to RBI. Random effects models were used. RESULTS: Fifty-nine studies (5,431 participants) met the inclusion criteria. There were 22 cohorts in CEA, 34 in CAS with distal protection, 8 in CAS with proximal protection, 9 in CAS without protection, and 9 in CAS with unspecified devices. Overall, 30.7% (95% confidence interval [CI] 26.6%-34.7%) had RBI, while 3.2% (95% CI 2.6%-3.8%) had clinical strokes or TIAs, with a stroke and TIA to RBI weighted ratio of 0.18 (95% CI 0.15-0.22). CEA had lower incidence of RBI compared to CAS (13.0% vs 37.4%) and also lower number of strokes and TIAs (1.8% vs 4.1%). The stroke and TIA to RBI ratio did not differ across 5 different types of carotid interventions (p = 0.58). CONCLUSIONS: One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/restrictedAccess
Language:
eng
Description:
El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Keywords:
Ischemia; Meta analysis; Carotid Endarterectomy; Carotid Artery Stenting
ISSN:
1526-632X

Full metadata record

DC FieldValue Language
dc.contributor.authorCho, Sung-Mines
dc.contributor.authorDeshpande, Abhishekes
dc.contributor.authorPasupuleti, Vinayes
dc.contributor.authorHernandez, Adrian V.es
dc.contributor.authorUchino, Kenes
dc.date.accessioned2017-10-27T20:04:31Z-
dc.date.available2017-10-27T20:04:31Z-
dc.date.issued2017-10-11-
dc.identifier.citationRadiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis. 2017 Neurologyes
dc.identifier.issn1526-632X-
dc.identifier.pmid29021357-
dc.identifier.doi10.1212/WNL.0000000000004626-
dc.identifier.urihttp://hdl.handle.net/10757/622326-
dc.descriptionEl texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.es
dc.description.abstractOBJECTIVE: In a systematic review, we compared ratio of new periprocedural radiographic brain ischemia (RBI) to the number of strokes and TIAs among patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS: We searched 5 databases for entries related to brain ischemia in CEA or CAS from inception through September 2015. We included articles with CEA or CAS and systematic performance of preprocedural and postprocedural brain MRI and reporting of RBI and stroke incidence. We calculated a symptomatic risk ratio of number of strokes and TIAs to RBI. Random effects models were used. RESULTS: Fifty-nine studies (5,431 participants) met the inclusion criteria. There were 22 cohorts in CEA, 34 in CAS with distal protection, 8 in CAS with proximal protection, 9 in CAS without protection, and 9 in CAS with unspecified devices. Overall, 30.7% (95% confidence interval [CI] 26.6%-34.7%) had RBI, while 3.2% (95% CI 2.6%-3.8%) had clinical strokes or TIAs, with a stroke and TIA to RBI weighted ratio of 0.18 (95% CI 0.15-0.22). CEA had lower incidence of RBI compared to CAS (13.0% vs 37.4%) and also lower number of strokes and TIAs (1.8% vs 4.1%). The stroke and TIA to RBI ratio did not differ across 5 different types of carotid interventions (p = 0.58). CONCLUSIONS: One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk.es
dc.formatapplication/pdfes
dc.language.isoenges
dc.publisherAmerican Academic of Neurologyes
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/?term=29021357%5Buid%5Des
dc.rightsinfo:eu-repo/semantics/restrictedAccesses
dc.subjectIschemiaes
dc.subjectMeta analysises
dc.subjectCarotid Endarterectomyes
dc.subjectCarotid Artery Stentinges
dc.titleRadiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysises
dc.typeinfo:eu-repo/semantics/articlees
dc.identifier.journalNeurologyes
dc.description.peerreviewRevisión por pareses_PE

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