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Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials.

Meier P, Knapp G, Tamhane U, Chaturvedi S, Gurm HS - BMJ (2010)

Bottom Line: In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1; P=0.314).Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke.Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.

View Article: PubMed Central - PubMed

Affiliation: University of Michigan Cardiovascular Center, Floor 2A 394, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5853, USA.

ABSTRACT

Objective: To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting.

Design: Systematic review and meta-analysis.

Data sources: BIOSIS, Embase, Medline, the Cochrane central register of controlled trials, International Pharmaceutical Abstracts database, ISI Web of Science, and Google scholar and bibliographies, from 1 January 1990 to 25 July 2009.

Study selection: Randomised controlled trials comparing carotid endarterectomy with carotid artery stenting in patients with carotid artery stenosis with or without symptoms.

Data extraction: Primary end point was a composite of mortality or stroke. Secondary end points were death, stroke, myocardial infarction, or facial neuropathy (as individual end points), and mortality or disabling stroke (as a composite end point).

Data synthesis: 11 trials were included (4796 patients); 10 reported on short term outcomes (n=4709) and nine on intermediate term outcomes (1-4 years). The periprocedural risk of mortality or stroke was lower for carotid endarterectomy (odds ratio 0.67, 95% confidence interval 0.47 to 0.95; P=0.025) than for carotid stenting, mainly because of a decreased risk of stroke (0.65, 0.43 to 1.00; P=0.049), whereas the risk of death (1.14, 0.56 to 2.31; P=0.727) and the composite end point mortality or disabling stroke (0.74, 0.53 to 1.05; P=0.088) did not differ significantly. The odds of periprocedural myocardial infarction (2.69, 1.06 to 6.79; P=0.036) or cranial nerve injury (10.2, 4.0 to 26.1; P<0.001) was higher in the carotid endarterectomy group than in the carotid stenting group. In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1; P=0.314).

Conclusions: Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke. Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.

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Fig 7 Forest plot of odds ratios of intermediate term risk for composite of stroke or death as binary outcomes, without considering time interval between intervention and event (Wallstent trial26 used an endpoint definition of “ipsilateral stroke, procedure-related death, or vascular death within 1 year”)
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fig7: Fig 7 Forest plot of odds ratios of intermediate term risk for composite of stroke or death as binary outcomes, without considering time interval between intervention and event (Wallstent trial26 used an endpoint definition of “ipsilateral stroke, procedure-related death, or vascular death within 1 year”)

Mentions: We also analysed event data based on the classic incidence of events (as for short term data). Binary data (events and total number of patients per group) were available for nine trials and did not show any difference in outcome (odds ratio 0.87, 95% confidence interval 0.71 to 1.07; P=0.190; I2=0%; P=0.432) (fig 7).


Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials.

Meier P, Knapp G, Tamhane U, Chaturvedi S, Gurm HS - BMJ (2010)

Fig 7 Forest plot of odds ratios of intermediate term risk for composite of stroke or death as binary outcomes, without considering time interval between intervention and event (Wallstent trial26 used an endpoint definition of “ipsilateral stroke, procedure-related death, or vascular death within 1 year”)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2821470&req=5

fig7: Fig 7 Forest plot of odds ratios of intermediate term risk for composite of stroke or death as binary outcomes, without considering time interval between intervention and event (Wallstent trial26 used an endpoint definition of “ipsilateral stroke, procedure-related death, or vascular death within 1 year”)
Mentions: We also analysed event data based on the classic incidence of events (as for short term data). Binary data (events and total number of patients per group) were available for nine trials and did not show any difference in outcome (odds ratio 0.87, 95% confidence interval 0.71 to 1.07; P=0.190; I2=0%; P=0.432) (fig 7).

Bottom Line: In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1; P=0.314).Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke.Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.

View Article: PubMed Central - PubMed

Affiliation: University of Michigan Cardiovascular Center, Floor 2A 394, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5853, USA.

ABSTRACT

Objective: To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting.

Design: Systematic review and meta-analysis.

Data sources: BIOSIS, Embase, Medline, the Cochrane central register of controlled trials, International Pharmaceutical Abstracts database, ISI Web of Science, and Google scholar and bibliographies, from 1 January 1990 to 25 July 2009.

Study selection: Randomised controlled trials comparing carotid endarterectomy with carotid artery stenting in patients with carotid artery stenosis with or without symptoms.

Data extraction: Primary end point was a composite of mortality or stroke. Secondary end points were death, stroke, myocardial infarction, or facial neuropathy (as individual end points), and mortality or disabling stroke (as a composite end point).

Data synthesis: 11 trials were included (4796 patients); 10 reported on short term outcomes (n=4709) and nine on intermediate term outcomes (1-4 years). The periprocedural risk of mortality or stroke was lower for carotid endarterectomy (odds ratio 0.67, 95% confidence interval 0.47 to 0.95; P=0.025) than for carotid stenting, mainly because of a decreased risk of stroke (0.65, 0.43 to 1.00; P=0.049), whereas the risk of death (1.14, 0.56 to 2.31; P=0.727) and the composite end point mortality or disabling stroke (0.74, 0.53 to 1.05; P=0.088) did not differ significantly. The odds of periprocedural myocardial infarction (2.69, 1.06 to 6.79; P=0.036) or cranial nerve injury (10.2, 4.0 to 26.1; P<0.001) was higher in the carotid endarterectomy group than in the carotid stenting group. In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1; P=0.314).

Conclusions: Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke. Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.

Show MeSH
Related in: MedlinePlus