Carotid Artery Stenting Versus Carotid Endarterectomy for Treatment of Asymptomatic Carotid Artery Stenosis

Abstract

SummaryAsymptomatic carotid stenosis is common and is associated with increased risk of stroke. The relative efficacy and safety of carotid endarterectomy (CEA) and carotid stenting (CAS) in patients with asymptomatic carotid stenosis remain unclear. Five studies that recruited patients with asymptomatic but significant carotid stenosis, who underwent CEA or CAS, were included in this systematic review and meta-analysis. The analyzed outcomes included risks of stroke, myocardial infarction (MI), and death. Risk ratio (RR) and 95% confidence interval (95% CI) were calculated and pooled for meta-analysis. Pooled analysis demonstrated that compared with CEA, CAS was associated with a decreased risk of MI (RR = 0.49, 95%CI = 0.26-0.91, P = 0.023) and slightly increased risk of stroke, although not significant (RR = 1.69, 95% CI = 0.97-2.92, P = 0.063). There was no difference in the death rates between the groups (RR = 0.60, 95% CI = 0.17-2.18, P = 0.436). In the subgroup analysis, CAS was associated with a decreased risk of MI in mixed patients (RR = 0.45, 95% CI = 0.26-0.78, P = 0.005), but not in asymptomatic patients (RR = 0.549, 95% CI = 0.26-1.17, P = 0.119). Compared with CAS, CEA was associated with decreased risk of perioperative stroke and increased risk of MI; it did not affect the risk of death in patients with asymptomatic carotid stenosis. In the subgroup analysis, the decreased risk of MI after CAS was significant only in the mixed patients group. CAS was associated with higher risk of stroke but lower risk of MI than those with CEA. Both procedures appeared equivalent in terms of the risk of death.(Int Heart J 2018; 59: 550-558)

Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis

“…Carotid stenosis is a known risk factor for stroke [1]. In population based studies, asymptomatic carotid stenosis can be found in up to 5.7%, with higher prevalence in men and with higher age [2, 3]. While carotid stenosis is usually termed “asymptomatic” in the absence of stroke related to the stenosis, there is continuous debate about detrimental effects of carotid stenosis on brain structure and cognition beyond the occurrence of cerebrovascular events.…”

A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications

“…It is adopted in a variety of vascular and cardiac procedures to reserve systemic heparin anticoagulation (Phair et al, 2020), especially for carotid recanalization (Lamanna et al, 2019). However, this inevitably leads to bleeding and then further cause major or minor strokes, myocardial infarction, or death (Yuan et al, 2018). Herein, we wonder whether protamine did affect the efficiency and safety of carotid recanalization and try to illustrate its safety and effectiveness in this surgery.…”

Comparison of postoperative results between carotid endarterectomy and carotid artery stenting for patients with contralateral carotid artery occlusion: A meta-analysis

“…The efficacy and safety of CEA and CAS in the treatment of carotid stenosis, also in an acute setting, is gradually getting recognized. 8 Yuan et al 26 performed CEA in 525 patients and CAS in 193 patients and showed that both reperfusion methods were useful for carotid artery atherosclerotic disease, but it was controversial for patients with CCO. 10 CCO may affect the intracranial collateral circulation and perioperative cerebral hemodynamics and then increase the risk of reperfusion.…”