Utility of Cerebral Embolic Protection Devices in Transcatheter Procedures: A Systematic Review and Meta-Analysis.

Autor: Baloch ZQ; Michigan State University/Sparrow Hospital Lansing, Lansing, MI. Electronic address: zulfiqar.qutrio@gmail.com., Haider SJ; University of Alabama, Birmingham, AL., Siddiqui HF; Department of Medicine, Dow University of Health Sciences., Shaikh FN; Department of Medicine, Dow University of Health Sciences., Shah BUD; Pakistan Institute of Medical Sciences - Islamabad, Islamabad, Pakistan., Ansari MM; Texas Tech University Health Sciences Center., Qintar M; Michigan State University/Sparrow Hospital Lansing, Lansing, MI.
Jazyk: angličtina
Zdroj: Current problems in cardiology [Curr Probl Cardiol] 2023 Jul; Vol. 48 (7), pp. 101675. Date of Electronic Publication: 2023 Mar 03.
DOI: 10.1016/j.cpcardiol.2023.101675
Abstrakt: With the emergence of the largest randomized control trial to date-the Stroke Protection With Sentinel During Transcatheter Aortic Valve Replacement (PROTECTED TAVR) study-we sought to conduct an updated meta-analyses to evaluate the utility of CEP devices on both clinical outcomes and neuroimaging parameters. Electronic databases were queried through November 2022 for clinical trials comparing the utility of Cerebral Embolic Protection (CEP) devices in Transcatheter Aortic Valve Replacement (TAVR) with non-CEP TAVR procedures. Meta-analyses were performed using the generic inverse variance technique, and a random-effects model, and results are presented as weighted mean differences (WMD) for continuous outcomes, and hazard ratios (HR) for dichotomous outcomes. Outcomes of interest included stroke, disabling stroke, nondisabling stroke, bleeding, mortality, vascular complications, new ischemic lesions, acute kidney injury (AKI), and total lesion volume. Thirteen studies (8 RCTs, 5 observational studies) consisting of 128,471 patients were included in the analysis. Results from our meta-analyses showed a significant reduction in stroke (OR: 0.84 [0.74-0.95]; P < 0.01; I 2  = 0%), disabling stroke (OR: 0.37 [0.21-0.67]; P < 0.01; I 2  = 0%) and bleeding events (OR: 0.91 [0.83-0.99]; P = 0.04; I 2  = 0%) through CEP device use in TAVR. The use of CEP devices had no significant impact on nondisabling stroke (OR: 0.94 [0.65-1.37]; P < 0.01; I 2  = 0%), mortality (OR: 0.78 [0.53-1.14]; P < 0.01; I 2  = 17%), vascular complications (OR: 0.99 [0.63-1.57]; P < 0.01; I 2  = 28%), AKI (OR: 0.78 [0.46-1.32]; P < 0.01; I 2  = 0%), new ischemic lesions (MD: -1.72 [-4.01, 0.57]; P < 0.001; I 2  = 95%) and total lesion volume (MD: -46.11 [-97.38, 5.16]; P < 0.001; I 2  = 81%). The results suggest that CEP device use was associated with a lower risk of disabling stroke and bleeding events in patients undergoing TAVR.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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