Carotid endarterectomy versus carotid angioplasty for stroke prevention: a systematic review and meta-analysis

Abstract

BackgroundThis meta-analysis aimed to evaluate the efficacy of carotid endarterectomy (CE) compared with carotid angioplasty (CA) in preventing stroke. Whether the use of CE is more efficient in preventing stroke than CA is a matter of debate.MethodsData were gathered from randomized controlled trials to evaluate the effect of CE compared with CA on the risk of stroke. Electronic searches in PubMed, Embase, and the Cochrane Library were performed to identify studies till November 2014. Only randomized controlled trials performed on patients who received either CE or CA for stroke prevention were included.ResultsNine relevant trials (n = 7163) that met the inclusion criteria were identified. In a pooled analysis, CE resulted in 35 % reduction in relative risk (RR) for short-term stroke [RR, 0.65; 95 % confidence interval (CI): 0.47–0.89; P = 0.007)] and 22 % reduction in RR for long-term stroke (RR, 0.78; 95 % CI: 0.66–0.93; P = 0.006) relative to CA. However, CE also increased the risk of 30-day myocardial infarction by 114 % compared with CA (RR, 2.14; 95 % CI: 1.30–3.53; P = 0.003). Sensitivity analyses suggested that CE might influence the risk of 30-day major vascular events and 1-year major vascular events compared with CA.ConclusionsCE could reduce the risk of stroke (whether short term or long term), but resulted in a relative increase in the risk of myocardial infarction. This study might guide appropriate judgments about treatment approach. It also provided evidence to justify general guidelines for patients with carotid artery stenosis.

Carotid artery stenting: Current state of evidence and future directions

“…2 Clinically important stenosis (the point at which the stroke risk is increased) varies between guidelines but is generally defined as stenosis >50% or >60%. 2 Clinically important stenosis (the point at which the stroke risk is increased) varies between guidelines but is generally defined as stenosis >50% or >60%.…”

“…1 Stroke is the second-leading cause of death and is the leading cause of premature mortality and morbidity for both men and women. 1,2 Atherosclerotic carotid artery stenosis is responsible for ~20% of strokes, typically occurring at the bifurcation of the internal and external carotid arteries. 3,4 Unfortunately, carotid atherosclerosis is often asymptomatic until a disabling or fatal stroke occurs.…”

“…Not all patients with carotid atherosclerosis are at increased risk of stroke; however, a strong association between severity of stenosis and stroke risk exists. 2 Clinically important stenosis (the point at which the stroke risk is increased) varies between guidelines but is generally defined as stenosis >50% or >60%. The prevalence of clinically significant carotid artery stenosis is ~0%-1% in the general population and ~1% in persons ≥65 years of age.…”

Effectiveness of interventions based on implantable devices: meta-analyses or systematic reviews that fail to indicate which device brands were used

“…Hence, after a standard PubMed search, we selected the following articles: area (1): meta-analysis by Diao et  al ,1 area (2): meta-analysis by Falk Delgado et al 2 and area (3) meta-analysis by Badger et al 3. The expert opinion for this choice was that of the three authors of this letter.…”

“…*This information was extracted from table 1 of Diao  et al 1 and Falk Delgado  et al 2 and pages 23–29 of Badger  et al 3…”