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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis

Published on: May 14, 2013

Percutaneous transluminal angioplasty and stenting for carotid artery stenosis

J Ederle, R L Featherstone, M M Brown

    The Cochrane Database of Systematic Reviews
    |October 19, 2007
    PubMed

    Insights

    Endovascular treatment for carotid artery stenosis shows mixed results compared to surgery. While it may reduce cranial neuropathy, carotid endarterectomy remains the recommended treatment of choice due to heterogeneous trial data.

    Area of Science:

    • Vascular Surgery
    • Interventional Neurology
    • Clinical Trials Methodology

    Background:

    • Endovascular treatment, including balloon angioplasty and stent insertion, presents a potential alternative to traditional carotid endarterectomy for managing carotid artery stenosis.
    • The clinical utility of endovascular approaches necessitates a thorough comparison against established surgical and medical interventions.

    Purpose of the Study:

    • To systematically evaluate the comparative benefits and risks associated with endovascular treatment versus carotid endarterectomy and medical therapy for carotid artery stenosis.
    • To determine if endovascular interventions offer a superior or equivalent safety and efficacy profile in managing carotid artery disease.

    Main Methods:

    • A comprehensive literature search was conducted across multiple databases (Cochrane Stroke Group, CENTRAL, MEDLINE, EMBASE, Science Citation Index) up to March 2007.
    • Randomized controlled trials comparing endovascular treatment with carotid endarterectomy or medical therapy for carotid artery stenosis were selected.
    • Data extraction and quality assessment were performed independently by two review authors to ensure reliability.

    Main Results:

    • Analysis of 12 trials (3227 patients) indicated that carotid endarterectomy (surgery) was favored for the primary outcome of any stroke or death within 30 days (OR 1.39, P=0.02).
    • Endovascular treatment showed benefits in reducing cranial neuropathy (OR 0.07, P<0.01) but had non-significant results for 30-day neurological complications or death (OR 0.62) due to heterogeneity.
    • No significant differences were observed between endovascular treatment and surgery for 30-day stroke, myocardial infarction, or death (OR 1.11), long-term stroke (OR 1.00), or in asymptomatic patients (OR 1.06).

    Conclusions:

    • The heterogeneity across trials, including patient populations, endovascular procedures, and follow-up durations, complicates definitive interpretation.
    • Early cessation of five trials may have overestimated endovascular treatment risks.
    • Current evidence does not support a shift away from recommending carotid endarterectomy as the primary treatment for suitable cases of carotid artery stenosis.
    Abstract

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