| Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials. | |
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MedLine Citation:
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PMID: 20502407 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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C Bakoyiannis; K P Economopoulos; S Georgopoulos; E Bastounis; E Papalambros |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Review |
Journal Detail:
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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:
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Created Date: 2010-05-26 Completed Date: 2010-09-03 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8402693 Medline TA: Int Angiol Country: Italy |
Other Details:
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Languages: eng Pagination: 205-15 Citation Subset: IM |
Affiliation:
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First Department of Surgery, Vascular Division, University of Athens, "Laiko" General Hospital, Athens, Greece. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty
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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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