Effectiveness and Safety of Carotid Endarterectomy Versus Carotid Artery Stenting in Treatment of Carotid Artery Stenosis: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 BAHETIKalifu , GUANSheng , TANGJIAREKE ,  GEXiao-hu

Department of Hepatobiliary and Vasular Surgery, People’s Hospital of The Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

GEXiao-hu, Email: gexiaohu_xj@163.com

Keywords：

Carotid artery stenosis; Carotid endarterectomy; Carotid artery stenting; Effectiveness; Safety

DOI：

10.7507/1007-9424.20160181

Video：

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Objective To update available evidence on safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in treatment of carotid artery stenosis by a meta-analysis of randomized controlled trials (RCTs). Methods A comprehensive search was performed of PubMed, EMBASE, Cochrane Library, Web of science, WanFang, and CNKI databases (from January 1990 to July 2015), to collect articles and past systematic reviews, and then abstraced lists of recent scientific conferences which were related with safety and efficacy of CEA versus CAS in treatment of carotid artery stenosis. At last, Meta analysis was performed by RevMan 5.1 software. Results Fifteen RCTs enrolling 9 828 patients were included in the Meta-analysis. Compared with CAS, CEA was associated with a significantly lower incidences of any stroke or death within 30 days after surgery (OR=0.63, 95% CI: 0.51-0.77, P＜0.05) and any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation (OR=0.61, 95% CI: 0.48-0.76, P＜0.05）, but associated with a significantly greater incidences of myocardial infarction (OR=1.81, 95% CI: 1.14-2.87, P=0.01) and cranial neuropathy (OR=18.28, 95% CI: 7.99-41.82, P＜0.05) within 30 days after surgery. Conclusion In comparison with CAS, CEA is associated with a lower incidences of stroke or death and a greater incidence of myocardial infarction and cranial neuropathy within 30 days after surgery, and was associated with a significantly lower incidence of any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation. So the results of Meta-analysis support continued use of CEA as the standard method in treatment of carotid artery stenosis.

Citation： BAHETIKalifu, GUANSheng, TANGJIAREKE, GEXiao-hu. Effectiveness and Safety of Carotid Endarterectomy Versus Carotid Artery Stenting in Treatment of Carotid Artery Stenosis: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(6): 676-681. doi: 10.7507/1007-9424.20160181 Copy

1.	Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation, 2011, 123(4): e18-e209.
2.	Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. N Engl J Med, 2000, 342(23): 1693-1700.
3.	Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med, 1998, 339(20): 1415-1425.
4.	European Carotid Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet, 1998, 351(9113): 1379-1387.
5.	Rerkasem K, Rothwell PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev, 2011, (4): CD001081.
6.	Mas JL, Arquizan C, Calvet D, et al. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke, 2014, 45(9): 2750-2756.
7.	Brooks WH, Jones MR, Gisler P, et al. Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC Cardiovasc Interv, 2014, 7(2): 163-168.
8.	Bonati LH, Dobson J, Featherstone RL, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet, 2015, 385(9967): 529-538.
9.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials, 1996, 17(1): 1-12.
10.	Naylor AR, Bolia A, Abbott RJ, et al. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg, 1998, 28(2): 326-334.
11.	Alberts MJ, Publications CW. Results of a multicenter prospective randomized trial of carotid artery stenting vs. carotid endarterectomy. Stroke, 2001, 32(1): 325.
12.	Brooks WH, Mcclure RR, Jones MR, et al. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol, 2001, 38(6): 1589-1595.
13.	Brown MM, Rogers J, Bland JM. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet, 2001, 357(9270): 1729-1737.
14.	Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med, 2004, 351(15): 1493-1501.
15.	Brooks WH, McClure RR, Jones MR, et al. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery, 2004, 54(2): 318-325.
16.	Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med, 2006, 355(16): 1660-1671.
17.	Ling F, Jiao LQ. Preliminary report of trial of endarterectomy versus stenting for treatment of carotid atherosclerotic stenosis in China (TESCAS-C). Chin J Cerebrovasc Dis, 2006, 3(1): 4-8.
18.	SPACE Collaborative Group; Ringleb PA, Allenberg J, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised noninferiority trial. Lancet, 2006, 368(9543): 1239-1247.
19.	Hoffmann A, Engelter S, Taschner C, et al. Carotid artery stenting versus carotid endarterectomy—a prospective randomized controlled single-centre trial with long-term follow-up (BACASS). Schweiz Arch Neurol Psychiatr, 2008, 159(14): 84-89.
20.	International Carotid Stenting Study investigators; Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet, 2010, 375(9719): 985-997.
21.	Brott TG, Hobson RW, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med, 2010, 363(1): 11-23.
22.	Rantner B, Goebel G, Bonati LH, et al. The risk of carotid artery stenting compared with carotid endarterectomy is greatest in patients treated within 7 days of symptoms. J Vasc Surg, 2013, 57(3): 619-626.
23.	Liu Z, Shi Z, Wang Y, et al. Carotid artery stenting versus carotid endarterectomy: systematic review and meta-analysis. World J Surg, 2009, 33(3): 586-596.

1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation, 2011, 123(4): e18-e209.
2. Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. N Engl J Med, 2000, 342(23): 1693-1700.
3. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med, 1998, 339(20): 1415-1425.
4. European Carotid Trialists’ Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet, 1998, 351(9113): 1379-1387.
5. Rerkasem K, Rothwell PM. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev, 2011, (4): CD001081.
6. Mas JL, Arquizan C, Calvet D, et al. Long-term follow-up study of endarterectomy versus angioplasty in patients with symptomatic severe carotid stenosis trial. Stroke, 2014, 45(9): 2750-2756.
7. Brooks WH, Jones MR, Gisler P, et al. Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC Cardiovasc Interv, 2014, 7(2): 163-168.
8. Bonati LH, Dobson J, Featherstone RL, et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet, 2015, 385(9967): 529-538.
9. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials, 1996, 17(1): 1-12.
10. Naylor AR, Bolia A, Abbott RJ, et al. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg, 1998, 28(2): 326-334.
11. Alberts MJ, Publications CW. Results of a multicenter prospective randomized trial of carotid artery stenting vs. carotid endarterectomy. Stroke, 2001, 32(1): 325.
12. Brooks WH, Mcclure RR, Jones MR, et al. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol, 2001, 38(6): 1589-1595.
13. Brown MM, Rogers J, Bland JM. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet, 2001, 357(9270): 1729-1737.
14. Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med, 2004, 351(15): 1493-1501.
15. Brooks WH, McClure RR, Jones MR, et al. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery, 2004, 54(2): 318-325.
16. Mas JL, Chatellier G, Beyssen B, et al. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med, 2006, 355(16): 1660-1671.
17. Ling F, Jiao LQ. Preliminary report of trial of endarterectomy versus stenting for treatment of carotid atherosclerotic stenosis in China (TESCAS-C). Chin J Cerebrovasc Dis, 2006, 3(1): 4-8.
18. SPACE Collaborative Group; Ringleb PA, Allenberg J, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised noninferiority trial. Lancet, 2006, 368(9543): 1239-1247.
19. Hoffmann A, Engelter S, Taschner C, et al. Carotid artery stenting versus carotid endarterectomy—a prospective randomized controlled single-centre trial with long-term follow-up (BACASS). Schweiz Arch Neurol Psychiatr, 2008, 159(14): 84-89.
20. International Carotid Stenting Study investigators; Ederle J, Dobson J, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet, 2010, 375(9719): 985-997.
21. Brott TG, Hobson RW, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med, 2010, 363(1): 11-23.
22. Rantner B, Goebel G, Bonati LH, et al. The risk of carotid artery stenting compared with carotid endarterectomy is greatest in patients treated within 7 days of symptoms. J Vasc Surg, 2013, 57(3): 619-626.
23. Liu Z, Shi Z, Wang Y, et al. Carotid artery stenting versus carotid endarterectomy: systematic review and meta-analysis. World J Surg, 2009, 33(3): 586-596.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness and Safety of Carotid Endarterectomy Versus Carotid Artery Stenting in Treatment of Carotid Artery Stenosis: A Meta-Analysis

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