Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis

Müller, Mandy D.; Lyrer, Philippe; Brown, Martin M.; Bonati, Leo H.

doi:10.1002/14651858.cd000515.pub5

Cited by 88 publications

(79 citation statements)

References 96 publications

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“…A Cochrane analysis comparing CEA to CAS was able to assess 30-day periprocedural risk of death and stroke by acquiring individual patient data from five trials. 10 Sex-specific assessments of long-term outcomes were largely limited to 5-year risk of stroke (ipsilateral or any)±death. 4 5 9 Sex-specific differences relating to the degree of stenosis were only reported in studies comparing CEA to BMT.…”

Section: Resultsmentioning

confidence: 99%

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Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review

et al. 2021

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ObjectiveNo systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients. In this scoping review, we aimed to identify all randomised controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularisation, and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design, setting and participantsWe systematically searched Medline, Embase, Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting, or any revascularisation (endarterectomy or stenting) with medical therapy in patients with symptomatic high-grade (>50%) carotid stenosis.ResultsFrom 1537 references examined, 27 eligible studies were identified. Sex-specific outcomes were reported in 13 studies. Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies. Common outcomes reported included stroke and death, however, there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes. Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy. Adverse events were not reported by sex.ConclusionsOnly half of the previously published RCTs and systematic reviews report sex-specific outcomes. Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.

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Section: Resultsmentioning

confidence: 99%

“…4 Comparing CEA to CAS at 30 days, there was a nonsignificant trend towards an increased hazard with CAS. 10 No study compared CAS to BMT. Adverse events were not reported by sex.…”

Section: Resultsmentioning

confidence: 99%

Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review

et al. 2021

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“…Approximately 6.5 million strokes occur per year. [1] Stroke is the second leading cause of death and is the leading cause of premature mortality and morbidity for both men and women. [2,3] Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes.…”

Section: Introductionmentioning

confidence: 99%

“…Concern regarding the risk of distal embolization of debris being dislodged from the atheromatous plaque during stent deployment and resulting in neurological deficit has led to the introduction and increasing use of cerebral embolic protection devices (EPD), but evidence on protection devices used during CAS is scarce since a small amount of randomized evidence comparing the different cerebral protection systems exists. [1] However, ESVS guidelines' class of recommendation for the use of EPDs in patients undergoing CAS is defined as class IIa. [8] The local anatomic and lesion factors increase the fluoroscopy time and risks associated with CAS [19] whereas systemic factors and comorbidities increase the risks associated with CEA.…”

Section: Introductionmentioning

confidence: 99%

Asemptomatik hastalarda karotis arter stentleme ve karotis endarterektominin prosedürel ve orta dönem sonuçları: Tek merkez deneyimi

Budak¹,

SARIYILDIZ²,

Günertem³

et al. 2020

Turkish Journal of Clinics and Laboratory

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Aim: Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes. The management of CS in an asymptomatic patient has been less clear. In situations were carotid endarterectomy (CEA) is thought to be more risky, surgeons must also have enough experience and capability to perform carotid artery stenting (CAS) to provide suitable, patient-tailored treatment. In this study, the same investigator performed all interventions (CAS and CEA), and one type of stenting device and EPD was used. In addition, periprocedural monitoring was carried out for at least 24 h. The objective of this study was to compare procedural results and 12-month follow-up outcomes of patients who were treated by the same operator-either CAS or CEA-in one year. Material and Methods: A retrospective single-center review involving asymptomatic patients with severe stenosis of the ICA caused by atherosclerotic disease who was treated with either stenting with embolic protection (Group 1, n=17) or carotid endarterectomy (group 2, n=18) according to their clinical and anatomical risk profile between

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“…The rationale behind treating carotid stenosis in the first place is the same behind treating carotid before coronary stenosis when concomitant [ 6 ]: a decrease in cardiac output may worsen ischemia downstream a carotid stenosis. Although carotid endarterectomy is considered in general safer and more effective than CAS [ 7 ], this is doubtful when concomitant NAVF is present, as NAVF has been an exclusion criteria in trials addressing safety and efficacy of carotid endarterectomy [ 8 ]. In these patients, CAS was preferred because it does not oblige to stop anticoagulation [ 9 ] and it is used in combination with a device that can stop cardiac emboli generated by reflex alteration of the cardiac rhythm by carotid baroreceptors.…”

mentioning

confidence: 99%

Left Atrial Appendage Occlusion: An Alternative to Triple Therapy in Stroke Patients Undergoing Carotid Angioplasty

et al. 2020

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Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis

Cited by 88 publications

References 96 publications

Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review

Identifying sex-specific differences in the carotid revascularisation literature: findings from a scoping review

Asemptomatik hastalarda karotis arter stentleme ve karotis endarterektominin prosedürel ve orta dönem sonuçları: Tek merkez deneyimi

Left Atrial Appendage Occlusion: An Alternative to Triple Therapy in Stroke Patients Undergoing Carotid Angioplasty

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