Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery Stenosis: A Meta-Analysis of Randomised Controlled Trials

Cui, Likun; Han, Yanshuo; Zhang, Shuai; Liu, Xun; Zhang, Jian

doi:10.1016/j.ejvs.2018.02.020

Cited by 45 publications

(18 citation statements)

References 34 publications

(45 reference statements)

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“…Eine weitere Metaanalyse zeigte einen signifikant geringeren Anteil periprozeduraler Schlaganfälle (vor allem leichter Schlaganfall) in der TEA-Gruppe verglichen zu CAS (OR 0,53; 95 %-KI 0,29-0,96). Keine signifikanten Unterschiede gab es in den Endpunkten periprozeduraler Tod, schwerer Schlaganfall, ipsilateraler Schlaganfall und Myokardinfarkt [27]. Nicht zuletzt in der SPACE-2-Studie konnte gezeigt werden, dass der größte Anteil an Schlaganfällen in der interventionellen Behandlung der ACS in der periprozeduralen Phase auftritt [20].…”

Section: Vergleich Thrombendarteriektomie Vs Karotisarterienstentingunclassified

Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Reiff¹,

Ringleb²

2021

Dtsch Med Wochenschr

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Section: Vergleich Thrombendarteriektomie Vs Karotisarterienstentingunclassified

Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Reiff¹,

Ringleb²

2021

Dtsch Med Wochenschr

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“…With regard to peri-procedural outcomes, a recent meta-analysis of 3901 asymptomatic patients randomly assigned to CEA ( n = 1585) or CAS ( n = 2316) reported that CAS was associated with a significantly higher risk of peri-procedural stroke than CEA (2.6% versus 1.3% respectively; p = 0.04) [ 65 ••]. This was largely driven by more minor strokes following CAS than CEA (2.2% versus 1.0%; p = 0.05) [ 65 ••]. Rates of death, major stroke, ipsilateral stroke and MI were comparable between CEA and CAS [ 65 ••].…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

“…This was largely driven by more minor strokes following CAS than CEA (2.2% versus 1.0%; p = 0.05) [ 65 ••]. Rates of death, major stroke, ipsilateral stroke and MI were comparable between CEA and CAS [ 65 ••].…”

Section: Conclusion and Future Perspectivesmentioning

confidence: 99%

Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

Gaba

Ringleb

Halliday

2018

Curr Neurol Neurosci Rep

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Purpose of ReviewProvide a current overview regarding the optimal strategy for managing patients with asymptomatic carotid artery stenosis.Recent FindingsCarotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce long-term stroke risk in asymptomatic patients. However, CAS is associated with a higher risk of peri-procedural stroke. Improvements in best medical therapy (BMT) have renewed uncertainty regarding the extent to which results from older randomised controlled trials (RCTs) comparing outcomes following carotid intervention can be generalised to modern medical practise.Summary‘Average surgical risk’ patients with an asymptomatic carotid artery stenosis of 60–99% and increased risk of late stroke should be considered for either CEA or CAS. In patients deemed ‘high risk’ for surgery, CAS is indicated. Use of an anti-platelet, anti-hypertensive and statin, with strict glycaemic control, is recommended. Results from ongoing large, multicentre RCTs comparing CEA, CAS and BMT will provide clarity regarding the optimal management of patients with asymptomatic carotid artery stenosis.

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“…Several randomized controlled trials have demonstrated the safety and efficacy of transfemoral carotid artery stenting (TF-CAS) and carotid endarterectomy (CEA) for symptomatic or asymptomatic CS (6)(7)(8)(9). However, TF-CAS has commonly been considered as an alternative to CEA, which is seen as the gold standard for treating CS (10)(11)(12). Even though TF-CAS has reached equivalent effects on late outcomes as CEA (13) and has been more favorable for patients with higher risks at anatomy or clinical picture (14).…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Transcarotid Artery Revascularization With Flow Reversal System Compared to Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Gao

Chen

Kou

et al. 2021

Front. Cardiovasc. Med.

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Background: Carotid artery stenosis has long been a critical cause of stroke and death, and it can seriously affect the life quality. Transcarotid artery revascularization (TCAR) and carotid endarterectomy (CEA) are both feasible therapies for this disease. This systematic review and meta-analysis aim to evaluate if the efficacy of the two approaches is comparable.Methods: Clinical studies up to March 2021 were searched through PubMed, Embase, and Scopus from a computer. The screening process was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Newcastle-Ottawa Scale (NOS) was used for methodological quality assessment of works of literature meeting the inclusion criteria, and Review Manager 5.4 was used for data synthesis. The I2 statistic was performed to measure the heterogeneity, and M-H/I-V fixed or random model was utilized depending on the I2 value. The evidence evaluation was accomplished based on grades of recommendation, assessment, development, and evaluation (GRADE) online tool.Results: A total of 14,200 subjects (six comparative studies) were finally included in this pooled study. There is no statistical discrepancy between the two treatments on reducing stroke/death/myocardial infarction (odds ratio [OR] 0.85, 95% CI 0.67–1.07), stroke (OR 1.03, 95% CI 0.77–1.37), or death (OR 1.14, 95% CI 0.67–1.94). Besides, TCAR is associated with a lower incidence of myocardial infarction (P = 0.004), cranial nerve injury (P < 0.00001), and shorter procedure time (P < 0.00001) than CEA among the overall cohort.Conclusions: TCAR is a rapidly developing treatment that reaches a comparable prognosis to CEA and significantly reduces the risk of myocardial infarction under the well-matched condition, which is a dependable choice for patients with carotid stenosis.

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Safety of Stenting and Endarterectomy for Asymptomatic Carotid Artery Stenosis: A Meta-Analysis of Randomised Controlled Trials

Abstract: Among patients with asymptomatic carotid stenosis, stenting has a significantly higher rate of any peri-procedural stroke and peri-procedural minor stroke than CEA, and similar risk of peri-procedural major stroke, peri-procedural ipsilateral stroke, or MI.

Cited by 45 publications

References 34 publications

Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Therapie bei asymptomatischer Stenose der extrakraniellen A. carotis

Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

The Efficacy of Transcarotid Artery Revascularization With Flow Reversal System Compared to Carotid Endarterectomy: A Systematic Review and Meta-Analysis

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