Short-Term Outcomes of Carotid Artery Stenting versus Carotid Endarterectomy in the Treatment of Carotid Stenosis: An Up-Dated Meta-Analysis of Randomized Controlled Trials

Authors : Izzet Aydemir, Ihsan Doğan, Afsun Ezel Esatoğlu

Pages : 242-250

Doi:10.18678/dtfd.1306382

View : 65 | Download : 111

Publication Date : 2023-12-30

Article Type : Research Paper

Abstract :Aim: Carotid artery stenting is thought to result in better outcomes when compared to carotid endarterectomy. To evaluate this hypothesis, a far-reaching of published randomized controlled trials were performed to evaluate the short-term outcomes of carotid artery stenting versus carotid endarterectomy for patients undergoing carotid artery stenosis. Material and Methods: A comprehensive search of trials published from 1994 until December 31, 2022, was performed using Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus, and Cochrane Central electronic databases. Major endpoints (any stroke, myocardial infarction, and all-cause mortality) were extracted from the publications. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a fixed-effects model. Results: 21 trials involving 15518 patients (8514 with stenting, 7004 with endarterectomy) were included in the meta-analysis. Stenting was associated with a significantly increased risk of short-term any stroke (RR=1.555, 95% CI: 1.307-1.851, p<0.001) yet a significantly decreased risk of short-term myocardial infarction (RR=0.458, 95% CI: 0.319-0.660, p<0.001) when compared with endarterectomy. No significant difference was found in all-cause mortality between the two interventions (RR=1.277, 95% CI: 0.835-1.952, p=0.259), but with a trend toward superiority favoring endarterectomy. Conclusion: Endarterectomy was found to be superior in terms of any stroke and partially regarding all-cause mortality, whereas stenting was found to be superior in terms of myocardial infarction. Yet for robust results, further studies are needed to address the relative effectiveness of stenting versus endarterectomy in the future.
Keywords : Karotis endarterektomi, meta analizi, randomize kontrollü çalışmalar, kısa dönem sonuçlar, karotis arter stentleme