Carotid artery stenting versus carotid endarterectomy: systematic review and meta-analysis
Zhenjie Liu1, Zhenyu Shi, Yuqi Wang
1Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.
Background:
The aim of this study was to evaluate and investigate the complications of carotid endarterectomy (CEA) and carotid artery stenting (CAS) by performing a meta-analysis based on prospective randomized controlled trials (RCTs).
Methods:
We performed a search of multiple electronic databases for RCTs containing patients with carotid stenosis who underwent CAS or CEA, focusing on studies published during 1995-2008.
Results:
Eight trials with 2942 patients (1462 with CEA, 1480 with CAS) were analyzed. The pooled relative risk (RR) after CEA for stroke/death 30 days or 1 year was similar to that for CAS. Thirty-day RR = 0.69, 95% confidence interval (CI) = 0.45-1.07, p = 0.10. One-year RR = 0.88, 95% CI = 0.43-1.79, p = 0.72. The rates of death, disabling stroke, and nondisabling stroke at 30 days did not differ significantly between CEA and CAS in the subgroup analysis. Compared with CEA, the relative risk of disabling stroke/death within 30 days was not significantly less for CAS with embolic protection devices (EPDs). The relative risk of myocardial infarction within 30 days, myocardial infarction within 1 year, and cervical/peripheral nerve injury within 30 days were significantly higher after CEA; the relative risk of bradycardia/hypotension within 30 days and the 1-year restenosis rate were significantly higher after CAS.
Conclusions:
CAS is equal to CEA with regard to the incidence of stroke/death. These procedures may be considered complementary rather than competing modes of therapy, each of which can be optimized with careful patient selection. CAS with an EPD may be appropriate in certain patients, and in general CAS should be considered cautiously in symptomatic patients.