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World Journal of Surgery

Published in:

01-03-2009

Carotid Artery Stenting Versus Carotid Endarterectomy: Systematic Review and Meta-Analysis

Authors: Zhenjie Liu, Zhenyu Shi, Yuqi Wang, Bin Chen, Ting Zhu, Yi Si, Weiguo Fu

Published in: World Journal of Surgery | Issue 3/2009

Abstract

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.

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Title: Carotid Artery Stenting Versus Carotid Endarterectomy: Systematic Review and Meta-Analysis
Authors: Zhenjie Liu
Zhenyu Shi
Yuqi Wang
Bin Chen
Ting Zhu
Yi Si
Weiguo Fu
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 3/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-008-9862-8

At a glance: The STEP trials

Springer Medicine

Carotid Artery Stenting Versus Carotid Endarterectomy: Systematic Review and Meta-Analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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