Document Detail


Carotid angioplasty with or without stent placement versus carotid endarterectomy for treatment of carotid stenosis: a meta-analysis.
MedLine Citation:
PMID:  15918933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Carotid angioplasty with or without stent placement (CAS) has been proposed as an alternative method to carotid endarterectomy (CEA) for treatment of carotid stenosis. Small randomized trials have evaluated the comparative efficacy of both methods; however, definitive evidence is lacking. METHODS: A search was made for randomized clinical trials comparing CAS and CEA for treatment of carotid stenosis. A literature search of MEDLINE, PubMed, and Cochrane databases was supplemented by a review of bibliographies of relevant articles and personal files. A meta-analysis was performed using a random effects model because significant heterogeneity was observed. Outcomes compared included 1-month composite rates of stroke or death, all strokes, disabling strokes, myocardial infarction, cranial nerve injury, and major bleeding and 1-year rates of both minor and major ipsilateral strokes. RESULTS: We analyzed five randomized trials totaling 1154 patients (577 randomized to CEA and 577 randomized to CAS). The composite end point of 1-month stroke or death rate was not different between patients treated with CAS compared with those treated with CEA (relative risk [RR], 1.3; 95% confidence interval [CI], 0.6-2.8; P = 0.5). The 1-month stroke rate (831 patients analyzed: RR, 1.3; 95% CI, 0.4-3.6; P = 0.7) and disabling stroke rate (831 patients analyzed: RR, 0.9; 95% CI, 0.2-3.5; P = 0.9) was similar for CAS and CEA. The 1-month rates of myocardial infarction (814 patients analyzed: RR, 0.3; 95% CI, 0.1-0.9) and cranial nerve injury (918 patients analyzed: RR, 0.05; 95% CI, 0.01-0.3) were significantly lower for CAS. No significant differences were observed in 1-year rates of ipsilateral stroke (814 patients analyzed: RR, 0.8; 95% CI, 0.5-1.2; P = 0.2). CONCLUSION: The 30-day stroke and death rates associated with CAS and CEA were not significantly different. Lower rates of myocardial infarction and cranial nerve injury were observed with CAS compared with CEA.
Authors:
Adnan I Qureshi; Jawad F Kirmani; Afshin A Divani; Robert W Hobson
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  Neurosurgery     Volume:  56     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-27     Completed Date:  2006-05-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1171-9; discussion 1179-81     Citation Subset:  IM    
Affiliation:
Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103-2425, USA. aiqureshi@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty / adverse effects,  methods*
Carotid Stenosis / surgery*
Disability Evaluation
Endarterectomy, Carotid / adverse effects,  methods*
Humans
MEDLINE / statistics & numerical data
Models, Statistical
Myocardial Infarction / etiology
Outcome Assessment (Health Care)
PubMed / statistics & numerical data
Randomized Controlled Trials as Topic
Risk
Stents*
Stroke / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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