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

IntroductionCarotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid-lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS.Methods and analysisThis protocol was designed based on the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Publication time for studies will be set from 1 January 2000 to 1 June 2020. We will search three databases: PubMed, EMBASE and The Cochrane Library. Suitable randomised controlled studies will be screened. The primary outcomes will include short-term and long-term mortality, stroke and myocardial infarction. OR and HR for dichotomous data and time-to-event data with 95% CIs will be calculated. Treatment effects among different therapies will be ranked according to the surface under the cumulative ranking curve and mean rank. A comprehensive evaluation of the risk of bias, heterogeneity and transitivity will be performed before data synthesis. Consistency and evidence quality will also be assessed.Ethics and disseminationThere will be no need for ethics approval as this systematic review is a summary and analysis of existing literature. Final results may be presented in international conferences or a peer-reviewed journal.PROSPERO registration numberCRD42019138942.

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Clinical considerations in the management of asymptomatic carotid artery stenosis

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11222 ◽

2011 ◽

Vol 31 (6) ◽

pp. E7 ◽

Cited By ~ 10

Author(s):

Philipp Taussky ◽

Ricardo A. Hanel ◽

Fredric B. Meyer

Keyword(s):

Carotid Artery ◽

Randomized Controlled Trials ◽

Carotid Artery Stenosis ◽

Risk Profile ◽

Artery Stenosis ◽

Controlled Trials ◽

Asymptomatic Carotid ◽

Randomized Controlled ◽

Asymptomatic Carotid Artery Stenosis ◽

Angioplasty And Stenting

Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.

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Oxidative injury associated with stenting of asymptomatic carotid artery stenosis

VASA ◽

10.1024/0301-1526/a000621 ◽

2017 ◽

Vol 46 (4) ◽

pp. 268-274

Author(s):

Erhan Saraçoğlu ◽

Ertan Vuruşkan ◽

Yusuf Çekici ◽

Salih Kiliç ◽

Halil Ay ◽

...

Keyword(s):

Oxidative Stress ◽

Carotid Artery ◽

Oxidative Damage ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Oxidative Stress Marker ◽

Asymptomatic Carotid ◽

Imaging Methods ◽

Neurological Findings ◽

Asymptomatic Carotid Artery Stenosis

Abstract. Background: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. Patients and methods: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after. Patients with elevated mRS scores but with or without typical hyperintense lesions observed on an MRI and with changes of oxidative stress marker levels at the time (Δtotal-thiol, Δtotal antioxidative status [TAS], and Δtotal oxidant status [TOS]) were evaluated. Results: In the neurological examination carried out one hour prior to the procedure, there were 92 patients with mRS = 0, 20 with mRS = 1, and 12 with mRS = 2. When Δtotal-thiol, ΔTAS, and ΔTOS values and the mRS were compared, it was observed that as the difference in oxidative parameters increased, clinical deterioration also increased proportionally (p = 0.001). Conclusions: We demonstrate a possible correlation between oxidative damage and neurological findings after CAS which could not be explained by routine imaging methods.

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