Carotid Revascularization: A Systematic Review of the Evidence

Al‐Damluji, Mohammed Salim; Nagpal, Sameer; Stilp, Erik; Remetz, Michael S.; Mena, Carlos

doi:10.1111/joic.12037

Cited by 6 publications

(7 citation statements)

References 61 publications

(117 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After the first phase of the selection process, 26 records were included for the second phase assessment. After reading all full texts, 17 SRs were included8–24 and 9 SRs were excluded with reasons 25–33. Reasons for exclusions at the second phase are presented in online supplementary file 2.…”

Section: Resultsmentioning

confidence: 99%

Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis

Mendoza

Latorraca

Oliveira

et al. 2019

BMJ EBM

View full text Add to dashboard Cite

A review of systematic reviews (SRs) and a critical appraisal study was conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). The objectives of this review are (1) to identify all published SRs comparing the effectiveness and safety of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for carotid artery stenosis, (2) to assess their methodological quality and (3) to compare the primary studies contained in each SR. We included 17 SRs published between 2005 and 2017. None of the SRs fulfilled all items of AMSTAR-2. The overall confidence in the results was graded as critically low for 16 SRs (94%) and low for 1 SR (6%). Five items were judged inadequate in all SRs: reference to a published protocol, explanation to the selection of study design, comprehensive search of the literature, methods for statistical combination of findings and consideration of the risk of bias on the results of meta-analysis. In total, 15 randomised clinical trials (RCTs) were included at least in one SR. The number of included RCTs in each SR was inconsistent (4 to 15) and was not related to the year of publication of the SR. Our study found redundant and low methodological quality SR comparing CAS versus CEA for carotid stenosis.

show abstract

Section: Resultsmentioning

confidence: 99%

Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis

Mendoza

Latorraca

Oliveira

et al. 2019

BMJ EBM

View full text Add to dashboard Cite

show abstract

“…The difference in the risk of readmission is likely driven in part by patient selection. Currently, CEA is the mainstay treatment of symptomatic and asymptomatic carotid artery stenosis, and CAS is typically reserved for patients with comorbidities or anatomy that put them at increased risk for adverse outcomes following CEA (1,15,16). Nevertheless, the risk of readmissions for CAS was higher than CEA even after accounting for observed differences in patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

Readmissions After Carotid Artery Revascularization in the Medicare Population

Al‐Damluji

Dharmarajan

Zhang

et al. 2015

Journal of the American College of Cardiology

Self Cite

View full text Add to dashboard Cite

Background In appropriately selected patients with severe carotid stenosis, carotid revascularization reduces ischemic stroke. Prior clinical research has focused on the efficacy and safety of carotid revascularization, but few investigators have considered readmission as a clinically important outcome. Objectives To examine frequency, timing, and diagnoses of 30-day readmission following carotid revascularization; to assess differences in 30-day readmission between patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS); to describe hospital variation in risk-standardized readmission rates (RSRR); and to examine whether hospital variation in procedural choice (CEA vs. CAS) was associated with differences in RSRRs. Methods We used Medicare fee-for-service administrative claims data to identify acute care hospitalizations for CEA and CAS from 2009–2011. We calculated crude 30-day all-cause hospital readmissions following carotid revascularization. To assess differences in readmission after CAS compared with CEA, we used Kaplan-Meier survival curves and fitted mixed-effect logistic regression. We estimated hospital RSRRs using hierarchical generalized logistic regression. We stratified hospitals into 5 groups by their proportional CAS use and compared hospital group median RSRRs. Results Of 180,059 revascularizations from 2,287 hospitals, CEA and CAS were performed in 81.5% and 18.5% of cases, respectively. The unadjusted 30-day readmission rate following carotid revascularization was 9.6%. Readmission risk after CAS was higher than after CEA. There was modest hospital-level variation in 30-day RSRRs (Median: 9.5%, Range: 7.5%–12.5%). Variation in proportional use of CAS was not associated with differences in hospital RSRR (range of median RSRR across hospital quartiles: 9.49%–9.55%, P 0.771). Conclusions Almost 10% of Medicare patients undergoing carotid revascularization were readmitted within 30-days of discharge. Compared with CEA, CAS was associated with higher readmission risk. However, hospitals’ RSRR did not differ by their proportional CAS use.

show abstract

“…38 However, studies have found the long-term risk of all strokes (major and minor) to be significantly higher for CAS than CEA, 39,40 with incidence rates reported to range from 7.9% to 10.1% for CEA and 9.0% to 14.2% for CAS. 38 A few trials have also reported a significantly higher rate of stroke in the periprocedure period for CAS, [39][40][41] although this risk may be mitigated by the use of embolic protective devices during stenting. 38 Acute thrombosis is a catastrophic event that requires immediate recognition and treatment with thrombolysis, endovascular thrombosuction, or open surgery.…”

Section: Thrombosis and Thromboembolismmentioning

confidence: 99%

“…38 A few trials have also reported a significantly higher rate of stroke in the periprocedure period for CAS, [39][40][41] although this risk may be mitigated by the use of embolic protective devices during stenting. 38 Acute thrombosis is a catastrophic event that requires immediate recognition and treatment with thrombolysis, endovascular thrombosuction, or open surgery. 42 The most frequently cited causes of acute thrombosis after CAS are failure to receive antiplatelet medication and technical failure, such as stent malposition and carotid dissection.…”

Section: Thrombosis and Thromboembolismmentioning

confidence: 99%

Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

Millet

Cavallo

Scoutt

et al. 2017

J of Ultrasound Medicine

View full text Add to dashboard Cite

Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided.

show abstract

Carotid Revascularization: A Systematic Review of the Evidence

Cited by 6 publications

References 61 publications

Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis

Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis

Readmissions After Carotid Artery Revascularization in the Medicare Population

Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions

Contact Info

Product

Resources

About