Objective

To investigate whether staged angioplasty (SAP) is a safe and effective treatment to prevent hyperperfusion syndrome after carotid artery stenting (CAS).

Methods

A systematic literature search was performed according to established criteria to identify eligible articles published before October 2020. Pooled dichotomous data were presented as odds ratios (OR) and corresponding 95% confidence intervals (CI) using random-effect models. The efficacy endpoints were hyperperfusion syndrome (HPS), hyperperfusion phenomenon (HPP), and intracerebral hemorrhage (ICH). The safety endpoint was post-procedural thromboembolic events. The feasibility of the procedure was assessed by device-related adverse events (vessel dissection and failed angioplasty) in SAP.

Results

Ten studies (1030 participants) were eligible. SAP was superior to regular CAS in preventing HPS (OR = 0.35, 95% CI 0.14–0.86, P = 0.02). There was no significant difference in the rate of thromboembolic events between the SAP group and the regular CAS group. The rates of vessel dissection and failed angioplasty with the use of a 3.0-mm-diameter balloon were 5.4% and 0.4%, respectively.

Conclusion

SAP may reduce the incidence of post-CAS HPS without increasing procedure-related complications. A 3.0-mm-diameter balloon used in SAP may be appropriate for Asian populations. However, the confounded study design and confused definitions of reporting items hinder the current recommendation of SAP in clinical use.

中文翻译：

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分期血管成形术：预防颈动脉支架置入术后高灌注综合征的明智方法？荟萃分析

客观的

探讨分期血管成形术 (SAP) 是否是预防颈动脉支架置入 (CAS) 后高灌注综合征的安全有效的治疗方法。

方法

根据既定标准进行系统文献检索，以确定 2020 年 10 月之前发表的符合条件的文章。使用随机效应模型将汇总的二分类数据表示为优势比 (OR) 和相应的 95% 置信区间 (CI)。疗效终点为高灌注综合征（HPS）、高灌注现象（HPP）和脑出血（ICH）。安全性终点是术后血栓栓塞事件。该程序的可行性通过 SAP 中与设备相关的不良事件（血管解剖和血管成形术失败）进行评估。

结果

十项研究（1030 名参与者）符合条件。SAP 在预防 HPS 方面优于常规 CAS（OR = 0.35, 95% CI 0.14–0.86, P = 0.02）。SAP 组和常规 CAS 组之间的血栓栓塞事件发生率没有显着差异。使用 3.0 毫米直径球囊的血管剥离率和血管成形术失败率分别为 5.4% 和 0.4%。

结论

SAP 可以降低 CAS 后 HPS 的发生率，而不会增加与手术相关的并发症。SAP 中使用的 3.0 毫米直径球囊可能适合亚洲人群。然而，混乱的研究设计和报告项目的混淆定义阻碍了当前在临床使用中的 SAP 推荐。