Early Outcomes of Carotid Revascularization in Retrospective Case Series
Petroula Nana1, George Kouvelos1, Alexandros Brotis2
1Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece.
Background:
Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities.
Methods:
A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis.
Results:
In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77-1.25; I2 = 0%), myocardial ischemic events (OR 1.03; 0.72-1.48; I2 = 0%) and all events (OR 1.0; 0.82-1.21; I2 = 0%). Pooled stroke incidence in asymptomatic patients was 1% (95% CI: 0-2%) for CEA and 1% for CAS (95% CI: 0-2%). Pooled stroke rate in symptomatic patients was 3% (95% CI: 1-4%) for CEA and 3% (95% CI: 1-4%) for CAS. The two techniques did not differ in either outcome both in asymptomatic and symptomatic patients.
Conclusion:
Carotid revascularization, performed in centers providing both CAS and CEA, is safe and effective. Both techniques did not differ in terms of post-procedural neurological and cardiac events, both in asymptomatic and symptomatic patients. These findings reiterate the importance of a tailored therapeutic strategy and that "real-world" outcomes may only be valid from centers providing both treatments.
