Document Detail


Endovascular Stenting or Carotid Endarterectomy for Treatment of Carotid Stenosis: A Meta-analysis.
MedLine Citation:
PMID:  21398144     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To compare carotid artery stenting with open carotid surgery for the treatment of symptomatic or asymptomatic carotid artery stenosis in terms of stroke, myocardial infarction, and death at 30 days. DESIGN: A meta-analysis of parallel randomized clinical trials (RCTs) (blind or open) published (full article available) in English. SETTING: University-based electronic search. INTERVENTIONS: Patients were submitted to carotid artery stenting or open carotid artery surgery. MEASUREMENTS AND MAIN RESULTS: Ten RCTs including 6,950 patients were found. There was a moderate amount of heterogeneity (I(2) = 49.8%) in stroke at 30 days when all available data were added together. Heterogeneity fell to 0% when only studies (n = 4) in which cerebral protection devices were used in a high percentage of the patients in the stenting groups were retained. Those 4 studies included 5,012 patients. Carotid endarterectomy reduced the risk ratio (RR) of stroke at 30 days compared with stenting (RR = 0.50; 95% confidence interval (CI), 0.38-0.67; p = 0.000002; event rate 2.8% and 5.6%). Carotid endarterectomy increases the risk of myocardial infarction (RR = 2.16 [95% CI, 1.32-3.54], p = 0.002, heterogeneity 0%, event rate 1.8% and 0.9%). There was no difference in death at 30 days (RR = 0.72 [0.42-1.24] (random effects model), p = 0.23, I(2) = 2.45%, p value for heterogeneity = 0.41; event rate 0.7% and 1.1% for carotid endarterectomy and stenting, respectively). CONCLUSIONS: Compared with stenting, carotid endarterectomy decreases the risk of stroke at 30 days, increases the risk of myocardial infarction, and does not affect the risk of death.
Authors:
Joanne Guay
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-11
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  -     ISSN:  1532-8422     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada.
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