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Incidence of Perioperative Outcomes After Carotid Revascularization With Special Emphasis on Myocardial Infarction -
Panagiota Valaki1, Konstantinos G Moulakakis2, Spyridon Mylonas3
1Department of Cardiology, General Hospital of Karditsa, Karditsa, Greece.
Insights
Carotid endarterectomy (CEA) reduces stroke risk compared to carotid artery stenting (CAS), but CAS shows lower rates of periprocedural myocardial infarction. Overall composite outcomes favor CEA for safety.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Evidence-Based Medicine
Background:
- Carotid revascularization is crucial for stroke prevention.
- Comparing safety and outcomes of carotid artery stenting (CAS) and carotid endarterectomy (CEA) is essential.
- Periprocedural myocardial infarction (PMI) is a key concern in these procedures.
Purpose of the Study:
- To estimate the incidence of periprocedural outcomes after carotid revascularization.
- To specifically assess the risk of myocardial infarction (MI) following CAS versus CEA.
- To systematically review and meta-analyze the safety of CAS and CEA.
Main Methods:
- Systematic review and meta-analysis of randomized control trials (RCTs).
- Searched major databases (PubMed, Web of Science, EMBASE, Cochrane) from 2000-2023.
- Included RCTs comparing 30-day perioperative events, focusing on MI, between CAS and CEA.
Main Results:
- Twelve RCTs with 11,153 patients were analyzed.
- CEA showed a reduced risk of periprocedural stroke compared to CAS (OR: 1.6).
- CAS demonstrated a lower incidence of periprocedural myocardial infarction (PMI) compared to CEA (OR: 0.4).
- The composite endpoint of stroke, MI, or death favored CEA (OR: 1.3).
Conclusions:
- CAS is associated with a lower risk of periprocedural myocardial infarction.
- Carotid endarterectomy appears safer regarding the composite endpoint of stroke, MI, or death.
- Current data do not indicate increased mortality rates with either procedure, despite differing risks for specific events.
Abstract:
Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) through systematic review and meta-analysis.MethodsA multiple electronic search was performed in Medline (database provider PubMed), Web of Science Core Collection, EMBASE (database provider Ovid) and Cochrane Central Register of Controlled Trials databases for articles from 2000 up to 2023 reporting outcomes after carotid revascularization. Randomized control trials comparing the perioperative events (30-day results) after CAS and CEA stating the perioperative risk of myocardial infarction were included in the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of twelve randomized control trials (RCTs) with 11 153 patients were identified and considered eligible. The pooled risk of periprocedural stroke was found to be reduced after CEA compared to CAS [OR: 1.6, CI 95%:1.3-2.1, P < 0.05], while PMI was found to be more frequent after CEA, favoring CAS [OR: 0.4, CI 95%: 0.2-0.7, P < 0.05]. Periprocedural mortality was lower but not reaching statistical significance in the CEA compared to CAS [OR: 1.1, CI 95%: 0.6-2.1, P = 0.68]. The pooled OR for composite endpoint of stroke, MI or death was in favor of CEA as safer treatment [OR: 1.3, CI 95%: 1-1.5, P < 0.05].ConclusionsPMI risk was lower after CAS, although the currently available data do not demonstrate any increase in mortality rates.
