Carotid artery stenting versus carotid endarterectomy: A comprehensive meta-analysis of short-term and long-term outcomes

Konstantinos P. Economopoulos, Theodoros N. Sergentanis, Georgios Tsivgoulis, Anargiros D. Mariolis, Christodoulos Stefanadis

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - The comparison between carotid endarterectomy and carotid artery stenting (CAS) remains a debated field, especially in the context of long-term outcomes. METHODS - Concerning the short-term (30-day) analysis, the numbers of outcomes per arm were abstracted, whereas outcomes per arm and hazard ratios were abstracted for long-term (≥1-year) results. RESULTS - Thirteen randomized trials (3723 carotid endarterectomy and 3754 CAS patients) were eligible. Regarding short-term outcomes, CAS was associated with elevated risk for stroke and "death or stroke." CAS also exhibited a marginal trend toward higher death and "death or disabling stroke" rates. Carotid endarterectomy presented with higher rates of myocardial infarction and cranial nerve injury. Concerning long-term outcomes, CAS was associated with higher rates of stroke (pooled OR, 1.37; 95% CI, 1.13 to 1.65) and "death or stroke" (pooled OR, 1.25; 95% CI, 1.06 to 1.48). These findings were replicated at the level of pooled hazard ratios and marginally regarding secondary preventive efficacy. The difference in long-term stroke rates was particularly sizeable in patients >68 years, but little difference in rates was observed in those <68 years. No statistically significant heterogeneity became evident. Metaregression did not reveal any significant modifying effect mediated by symptomatic/asymptomatic status, distal protection, early termination of trials, area of study origin, or CAS learning curve. CONCLUSIONS - This meta-analysis points to the significantly less frequent stroke events after carotid endarterectomy at the long-term context. The outcomes of carotid endarterectomy seem superior to CAS, but there may be subgroups, particularly younger patients, in whom the results seem equivalent.

Original languageEnglish (US)
Pages (from-to)687-692
Number of pages6
JournalStroke
Volume42
Issue number3
DOIs
StatePublished - Mar 1 2011

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Carotid Endarterectomy
Carotid Arteries
Meta-Analysis
Stroke
Cranial Nerve Injuries
Learning Curve
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Carotid artery stenting versus carotid endarterectomy : A comprehensive meta-analysis of short-term and long-term outcomes. / Economopoulos, Konstantinos P.; Sergentanis, Theodoros N.; Tsivgoulis, Georgios; Mariolis, Anargiros D.; Stefanadis, Christodoulos.

In: Stroke, Vol. 42, No. 3, 01.03.2011, p. 687-692.

Research output: Contribution to journalArticle

Economopoulos, Konstantinos P. ; Sergentanis, Theodoros N. ; Tsivgoulis, Georgios ; Mariolis, Anargiros D. ; Stefanadis, Christodoulos. / Carotid artery stenting versus carotid endarterectomy : A comprehensive meta-analysis of short-term and long-term outcomes. In: Stroke. 2011 ; Vol. 42, No. 3. pp. 687-692.
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