| Endovascular Stenting or Carotid Endarterectomy for Treatment of Carotid Stenosis: A Meta-analysis. | |
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MedLine Citation:
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PMID: 21398144 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Joanne Guay |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-3-11 |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: - ISSN: 1532-8422 ISO Abbreviation: - Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-3-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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