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Endarterectomy achieves lower stroke and death rates compared with stenting in patients with asymptomatic carotid stenosis.

Abstract It is currently unclear if carotid artery stenting (CAS) is as safe as carotid endarterectomy (CEA) for patients with significant asymptomatic stenosis. The aim of our study was to perform a systematic review and meta-analysis of trials comparing CAS with CEA.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title journal of vascular surgery
Publication Year Start




PMID- 28735954
OWN - NLM
STAT- In-Process
DA  - 20170724
LR  - 20170724
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 66
IP  - 2
DP  - 2017 Aug
TI  - Endarterectomy achieves lower stroke and death rates compared with stenting in
      patients with asymptomatic carotid stenosis.
PG  - 607-617
LID - S0741-5214(17)31256-9 [pii]
LID - 10.1016/j.jvs.2017.04.053 [doi]
AB  - BACKGROUND: It is currently unclear if carotid artery stenting (CAS) is as safe
      as carotid endarterectomy (CEA) for patients with significant asymptomatic
      stenosis. The aim of our study was to perform a systematic review and
      meta-analysis of trials comparing CAS with CEA. METHODS: On March 17, 2017, a
      search for randomized controlled trials was performed in MEDLINE and Scopus
      databases with no time limits. We performed meta-analyses with Peto odds ratios
      (ORs) and 95% confidence intervals (CIs). Quality of evidence was assessed with
      the Grading of Recommendations Assessment, Development, and Evaluation method.
      The primary safety and efficacy outcome measures were stroke or death rate at 30 
      days and ipsilateral stroke at 1 year (including ipsilateral stroke and death
      rate at 30 days), respectively. Perioperative stroke, ipsilateral stroke,
      myocardial infarction (MI), and cranial nerve injury (CNI) were all secondary
      outcome measures. RESULTS: The systematic review of the literature identified
      nine randomized controlled trials reporting on 3709 patients allocated into CEA
      (n = 1479) or CAS (n = 2230). Stroke or death rate at 30 days was significantly
      higher for CAS (64/2176 [2.94%]) compared with CEA (27/1431 [1.89%]; OR, 1.57;
      95% CI, 1.01-2.44; P = .044), with low level of heterogeneity beyond chance (I2 =
      0%). Also, stroke rate at 30 days was significantly higher for CAS (63/2176
      [2.90%]) than for CEA (26/1431 [1.82%]; OR, 1.63; 95% CI, 1.04-2.54; P = .032; I2
      = 0%). MI at 30 days was nonsignificantly lower for CAS (12/1815 [0.66%])
      compared with CEA (16/1070 [1.50%]; OR, 0.53; 95% CI, 0.24-1.14; P = .105; I2 =
      0%); however, CNI at 30 days was significantly lower for CAS (2/1794 [0.11%])
      than for CEA (33/1061 [3.21%]; OR, 0.13; 95% CI, 0.07-0.26; P < .00001; I2 = 0%).
      Regarding the long-term outcome of stroke or death rate at 30 days plus
      ipsilateral stroke during follow-up, this was significantly higher for CAS
      (79/2173 [3.64%]) than for CEA (35/1430 [2.45%]; OR, 1.51; 95% CI, 1.02-2.24; P =
      .04; I2 = 0%). Quality of evidence for all stroke outcomes was graded moderate.
      CONCLUSIONS: Among patients with asymptomatic stenosis undergoing carotid
      intervention, there is moderate-quality evidence to suggest that CEA had
      significantly lower 30-day stroke and also stroke or death rates compared with
      CAS at the cost of higher CNI and nonsignificantly higher MI rates. The long-term
      efficacy of CEA in ipsilateral stroke prevention, taking into account
      perioperative stroke and death, was preserved during follow-up. There is an
      urgent need for high-quality research before a firm recommendation is made that
      CAS is inferior or not to CEA.
CI  - Copyright (c) 2016 Society for Vascular Surgery. Published by Elsevier Inc. All
      rights reserved.
FAU - Kakkos, Stavros K
AU  - Kakkos SK
AD  - Department of Vascular Surgery, University of Patras Medical School, Patras,
      Greece; Department of Surgery and Cancer, Imperial College London, London, United
      Kingdom. Electronic address: [email protected]
FAU - Kakisis, Ioannis
AU  - Kakisis I
AD  - National and Kapodistrian University of Athens, Athens, Greece.
FAU - Tsolakis, Ioannis A
AU  - Tsolakis IA
AD  - Department of Vascular Surgery, University of Patras Medical School, Patras,
      Greece.
FAU - Geroulakos, George
AU  - Geroulakos G
AD  - Department of Surgery and Cancer, Imperial College London, London, United
      Kingdom; National and Kapodistrian University of Athens, Athens, Greece.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
EDAT- 2017/07/25 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/07/25 06:00
PHST- 2016/11/16 [received]
PHST- 2017/04/10 [accepted]
AID - S0741-5214(17)31256-9 [pii]
AID - 10.1016/j.jvs.2017.04.053 [doi]
PST - ppublish
SO  - J Vasc Surg. 2017 Aug;66(2):607-617. doi: 10.1016/j.jvs.2017.04.053.