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

View Article: PubMed Central - PubMed

ABSTRACT

Background: This 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.

Methods: Data 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.

Results: Nine 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.

Conclusions: CE 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.

No MeSH data available.


Flow diagram of the literature search and trials selection process
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Fig1: Flow diagram of the literature search and trials selection process

Mentions: Of the 19 trials retrieved for detailed assessment, 10 were excluded because: they lacked data on stroke, they reported on the same study population, [17] they were of small sample size, or it was a stopped trial. The final analysis included nine randomized controlled trials [18–26] consisting of 7163 patients with carotid artery stenosis (Fig. 1). These trials compared CE with CA, with stroke reported as one of the endpoints. Table 1 summarizes the characteristics of these trials and the important baseline information of the included 7163 patients. Of the nine trials, two were performed in the USA [18, 20], four in European countries [19, 21, 22, 24], one [23] in Germany, Austria, and Switzerland, one [25] in the USA and Canada, and one [26] in Europe, Australia, and Canada. The number of patients ranged from 87 to 2502. The percentage of previous cases with cardiovascular disease ranged from 11.9 to 80.7 %. The duration of follow-up ranged from 0.3 to 5.4 years. The inclusion criteria were restricted to randomized controlled trials with the number of patients more than 50 to ensure that high-quality literature was included in the study. Although the included trials scarcely reported on the key indicators of trial quality, the quality of the included trials was also evaluated according to the predefined criteria using the Jadad score [11]. Overall, five [20–23, 25] of the included trials scored 4, two trials [19, 26] scored 3, and the remaining two trials [18, 24] scored 2.Fig. 1


Carotid endarterectomy versus carotid angioplasty for stroke prevention: a systematic review and meta-analysis
Flow diagram of the literature search and trials selection process
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5017049&req=5

Fig1: Flow diagram of the literature search and trials selection process
Mentions: Of the 19 trials retrieved for detailed assessment, 10 were excluded because: they lacked data on stroke, they reported on the same study population, [17] they were of small sample size, or it was a stopped trial. The final analysis included nine randomized controlled trials [18–26] consisting of 7163 patients with carotid artery stenosis (Fig. 1). These trials compared CE with CA, with stroke reported as one of the endpoints. Table 1 summarizes the characteristics of these trials and the important baseline information of the included 7163 patients. Of the nine trials, two were performed in the USA [18, 20], four in European countries [19, 21, 22, 24], one [23] in Germany, Austria, and Switzerland, one [25] in the USA and Canada, and one [26] in Europe, Australia, and Canada. The number of patients ranged from 87 to 2502. The percentage of previous cases with cardiovascular disease ranged from 11.9 to 80.7 %. The duration of follow-up ranged from 0.3 to 5.4 years. The inclusion criteria were restricted to randomized controlled trials with the number of patients more than 50 to ensure that high-quality literature was included in the study. Although the included trials scarcely reported on the key indicators of trial quality, the quality of the included trials was also evaluated according to the predefined criteria using the Jadad score [11]. Overall, five [20–23, 25] of the included trials scored 4, two trials [19, 26] scored 3, and the remaining two trials [18, 24] scored 2.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: This 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.

Methods: Data 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.

Results: Nine 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.

Conclusions: CE 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.

No MeSH data available.