Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: A meta-analysis

Abstract Background Our group previously described the protocol-based decision for choosing the proper surgical treatment option for carotid artery stenosis. The objective of this study is to describe our experiences of using this scoring protocol in the selection of endarterectomy or stenting for carotid artery stenosis. Methods Between October 2014 and March 2018, the scoring protocol was applied to a total of 105 consecutive patients. Eighty (76.2%) patients had symptomatic stenosis ≥50%, and 25 (23.8%) patients had asymptomatic stenosis ≥80%. We also speculated about how effectively the protocol worked in the real clinical setting. Results Stenting was performed in 73 patients and endarterectomy in 32 patients. Overall, 98 (93.3%) patients were treated according to the protocol, while the protocol was violated in seven (6.7%) patients. Sixty-one (58.1%) patients received treatments that were decided by the protocol. There were 37 (35.2%) patients who had the same score for both treatment options. Among these patients, 28 patients underwent stenting and nine patients underwent endarterectomy. In the stenting cases, 90.4% of the patients followed the protocol and violations occurred in 9.6%. In the endarterectomy cases, all of the patients followed the protocol. Overall, one patient had a procedure-related complication without morbidity. During the 12-month follow-ups, there were no restenoses or major strokes. Minor strokes were diagnosed in three (2.8%) patients. Conclusion In patients with carotid artery stenosis, stenting and endarterectomy should be considered simultaneously together, not against each other. Our scoring protocol can be used to weigh these options and applied in clinical practice.

Download Full-text

Evolution of surgical treatment of carotid artery stenosis: a single center observational study

Acta Chirurgica Belgica ◽

10.1080/00015458.2019.1607489 ◽

2019 ◽

Vol 120 (5) ◽

pp. 301-309

Author(s):

Gilles Soenens ◽

Nathalie Moreels ◽

Frank Vermassen ◽

Veerle De Herdt ◽

Dimitri Hemelsoet ◽

...

Keyword(s):

Surgical Treatment ◽

Carotid Artery ◽

Observational Study ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Single Center ◽

Single Center Observational Study

Download Full-text

Revascularization Versus Best Medical Therapy for the Management of Asymptomatic Carotid Artery Stenosis in Females: A Systematic Review and Meta-Analysis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.08.064 ◽

2020 ◽

Vol 72 (5) ◽

pp. e353

Author(s):

Shira A. Strauss ◽

Chau Huynh ◽

Baies Haqani ◽

Na Zeng ◽

Prasad Jetty

Keyword(s):

Systematic Review ◽

Carotid Artery ◽

Medical Therapy ◽

Carotid Artery Stenosis ◽

Meta Analysis ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis ◽

Best Medical Therapy

Download Full-text

Surgical Treatment of Recurrent Carotid Artery Stenosis and Carotid Artery Stenosis after Neck Irradiation: Evaluation of Operative Risk

Annals of Vascular Surgery ◽

10.1007/s10016-003-0020-3 ◽

2003 ◽

Vol 17 (4) ◽

pp. 393-400 ◽

Cited By ~ 15

Author(s):

S. Cazaban ◽

D. Maiża ◽

O. Coffin ◽

J.M. Radoux ◽

C. Mai ◽

...

Keyword(s):

Surgical Treatment ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Operative Risk ◽

Neck Irradiation

Download Full-text

Carotid Endarterectomy Versus Stenting: A Meta-Analysis of Randomized Trials

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011380 ◽

2011 ◽

Vol 38 (2) ◽

pp. 230-235 ◽

Cited By ~ 29

Author(s):

Daniel Yavin ◽

Derek J. Roberts ◽

Michael Tso ◽

Garnette R. Sutherland ◽

Misha Eliasziw ◽

...

Keyword(s):

Myocardial Infarction ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Meta Analysis ◽

Artery Stenosis ◽

Cranial Neuropathy ◽

Cardiac Complications ◽

Lower Odds

Background:A meta-analysis of randomized controlled trials (RCTs) was conducted to update the available evidence on the safety and efficacy of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in the treatment of carotid artery stenosis.Methods:A comprehensive search was performed of MEDLINE, EMBASE, CENTRAL, bibliographies of included articles and past systematic reviews, and abstract lists of recent scientific conferences. For each reported outcome, a Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CI). The I2 statistic was used as a measure of heterogeneity.Results:Twelve RCTs enrolling 6,973 patients were included in the meta-analysis. Carotid artery stenting was associated with a significantly greater odds of periprocedural stroke (OR 1.72, 95% CI 1.20 to 2.47) and a significantly lower odds of periprocedural myocardial infarction (OR 0.47, 95% CI 0.29 to 0.78) and cranial neuropathy (OR 0.08, 95% CI, 0.04 to 0.16). The odds of periprocedural death (OR 1.11, 95% CI 0.56 to 2.18), target vessel restenosis (OR 1.95, 95% CI 0.63 to 6.06), and access-related hematoma were similar following either intervention (OR 0.60, 95% CI 0.30 to 1.21).Conclusions:In comparison with CEA, CAS is associated with a greater odds of stroke and a lower odds of myocardial infarction. While the results our meta-analysis support the continued use of CEA as the standard of care in the treatment of carotid artery stenosis, CAS is a viable alternative in patients at elevated risk of cardiac complications.

Download Full-text