Document Detail


Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  20502407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Carotid angioplasty with or without stent placement (CAS) has been proposed as an alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. We performed a systematic review and meta-analysis of randomized controlled trials to compare the safety and efficacy of endovascular techniques with surgery for carotid stenosis. We searched MEDLINE, PubMed and Cochrane databases to identify randomized controlled trials comparing CAS with CEA. Both random and fixed effects models were used to calculate the pooled odds ratios (OR) and their confidence intervals, with values lower than one indicating a benefit from the endovascular approach. Continuity correction was used for studies with zero events in one arm. We identified 11 trials randomizing a total of 3 258 patients; 1 623 to CEA and 1 635 to CAS. By random effects model, there was no significant difference between the treatments for any stroke (OR, 1.28; 95% CI, 0.82-2.02), or death or any stroke at 30-day (OR, 1.30; 95% CI, 0.92-1.84) and death or any stroke at 6 months (OR, 1.34; 95% CI, 0.86-2.09) or 1 year (OR, 1.41; 95% CI, 0.24-8.27). However there was a significantly higher risk of 30-day death or any stroke (OR, 1.33; 95% CI, 1.01-1.75) after CAS by fixed effects model. Endovascular treatment significantly reduced the risk of 30-day cranial nerve injury (OR, 0.13; 95% CI, 0.04-0.44). In conclusion treating carotid artery stenosis with CAS offers lower rates of cranial nerve injury compared with CEA. CAS could not be proved to be as safe as CEA in treating carotid artery stenosis. The results of ongoing randomized trials comparing CAS with CEA are easily awaited because they may provide sufficient evidence for a change in clinical practice.
Authors:
C Bakoyiannis; K P Economopoulos; S Georgopoulos; E Bastounis; E Papalambros
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  International angiology : a journal of the International Union of Angiology     Volume:  29     ISSN:  1827-1839     ISO Abbreviation:  Int Angiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-26     Completed Date:  2010-09-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8402693     Medline TA:  Int Angiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  205-15     Citation Subset:  IM    
Affiliation:
First Department of Surgery, Vascular Division, University of Athens, "Laiko" General Hospital, Athens, Greece.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty / adverse effects,  instrumentation*,  mortality
Carotid Stenosis / mortality,  surgery,  therapy*
Cranial Nerve Injuries / etiology
Endarterectomy, Carotid* / adverse effects,  mortality
Evidence-Based Medicine
Humans
Odds Ratio
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Stents*
Stroke / etiology
Time Factors
Treatment Outcome

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


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