Comparison of Thromboembolic Complications After Carotid Artery Stenting with and without Using Protection Devices: A Meta-Analysis study Short title: Comparison of Thromboembolic Complications After Carotid Artery Stenting with and without Using Protection Devices

Abstract

Objective This study has been designed to compare the rate of thromboembolic events during Carotid angioplasty and stenting (CAS) with and without embolic protection devices (EPDs). So we systematically reviewed the literature to find and select studies that compared the rate of embolic events during CAS with and without embolic protection devices and conducted a meta-analysis to find which way is better. Methods Embase, PubMed, and Web of Science databases were thoroughly searched. By using random-effects models, each estimation was executed. To assess the heterogeneity among the studies I2 index was used. Egger and Begg’s tests were applied to evaluate publication bias. Stata version 14.2 was used for the statistical analysis. Results For 25% of patients, EPD was used during CAS, and for 75%, did not. The prevalence of hypertension, diabetes mellitus, coronary artery disease, and cigarette smoking was 77%, 37%, 40%, and 44%. 52% of included patients were symptomatic, and 48% of them were asymptomatic .The mortality rate reduced from 2% in the no_EPD subgroup to 1% among the EPD subgroup. The occurrence of all other complications was also reportedly higher in patients who did not receive EPD, including major stroke and MI, except for minor events, which were reported to be almost the same in both subgroups. Conclusion we found out that the use of EPD can help with reducing the occurrence of thromboembolic complications of CAS, including MI, major stroke, and death. Altogether, our results suggest that the benefits of using EPD during CAS outweigh its risks.