Endarterectomy or carotid artery stenting: the quest continues part two (original) (raw)
Related papers
2019
Background/aim: Although carotid endarterectomy (CEA) has long been considered the preferred intervention for carotid occlusive disease, carotid angioplasty and stenting (CAS) may serve as a minimally invasive alternative with equivalency in providing protection against ipsilateral stroke. The aim of the present study was tocompare the outcomesof both treatment modalities at a single center. Methods: We retrospectively analyzed patients with carotid artery stenosis admitted to our hospital for carotid revascularization in a 14-year period. Eligibility criteria for revascularization were determined on the basis of symptomatic stenosis over 70% or asymptomatic stenosis over 80%. The primary outcome was a composite of periprocedural death, stroke, and myocardial infarction (MI). Results: Of the 483 patients admitted for carotid revascularization 283 (58.6%) underwent CEA and 200 (41.4%) CAS. In total 301 CEAand 207 CAS procedures were performed. Symptomatic lesions were similar between...
ABSTRACT Background: The efficacy of carotid endarterectomy (CEA) has been validated by several multicentre, randomized trials. At present, comparative studies are mounting insight into the role of carotid angioplasty and stenting (CAS), also optimizing patient selection based on factors identification. CAS has been proposed as an alternative to CEA for the treatment of carotid endarterectomy. Aim: To equate the safety and efficacy of endovascular techniques i.e. CAS and CEA with surgery for carotid stenosis, we implemented a systematic review and meta-analysis of randomized controlled trials. Methods: We recognized 8 trials randomizing a total of 2250 patients; 1123 to CEA and 1127 to CAS. Search was made through various databases i.e., PubMed, MEDLINE etc, to identify randomized controlled trials comparing CAS with CEA. To calculate the pooled odds ratios (OR) and their confidence intervals, both fixed and random effects models were used. A lower value to one indicates benefit from endovascular approach. Results: There was no significant difference between the treatments even with random effect model (OR=1.10; 95%), also there is no difference with deaths or any stroke at 30 days (OR = 1.21; 95%). But by fixed effect model, a significantly higher death/ stroke risk were estimated (OR, 1.11; 95%) after CAS. Conclusion: Treating carotid endarterectomy with CAS suggests lower rates of cranial nerve injury in comparison to CEA. CAS may perhaps not be verified, to be as nonviolent as CEA in treating carotid endarterectomy. Keywords: Endarterectomy, carotid angioplasty and stenting, endovascular treatment,
Interactive cardiovascular and thoracic surgery, 2005
A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether carotid artery stenting (CAS) is equivalent or even superior to carotid endarterectomy (CEA) for the treatment of significant carotid artery stenosis. Four hundred and ninety-four papers were identified, of which 14 papers including five randomised controlled trials (RCTs) presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We conclude that the risk of peri-procedure stroke or death was similar for patients treated with carotid artery angioplasty+/-stenting and those treated with surgery. However, CAS did reduce the risk of minor complications at the site of vascular access, the incidence of cranial nerve injury, and may reduce economic costs due to shorter hospital stays and earlier re...
Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis
The New England journal of medicine, 2016
Background In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years. Methods Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers. In addition to assessing the primary composite end point, we assessed the primary end point for the long-term extension study, which was ipsilateral stroke after the periprocedural period. Results Among 2502 patients, there was no significant difference in the rate of the primary composite end point between the stenting group (11.8%; 95% confidence interval [CI], 9.1 to 14.8) and the endarterectomy group (...
Stenting versus Endarterectomy for Treatment of Carotid-Artery Stenosis
Journal of Vascular Surgery, 2010
Carotid-artery stenting and carotid endarterectomy are both options for treating carotid-artery stenosis, an important cause of stroke. We randomly assigned patients with symptomatic or asymptomatic carotid stenosis to undergo carotid-artery stenting or carotid endarterectomy. The primary composite end point was stroke, myocardial infarction, or death from any cause during the periprocedural period or any ipsilateral stroke within 4 years after randomization. For 2502 patients over a median follow-up period of 2.5 years, there was no significant difference in the estimated 4-year rates of the primary end point between the stenting group and the endarterectomy group (7.2% and 6.8%, respectively; hazard ratio with stenting, 1.11; 95% confidence interval, 0.81 to 1.51; P=0.51). There was no differential treatment effect with regard to the primary end point according to symptomatic status (P=0.84) or sex (P=0.34). The 4-year rate of stroke or death was 6.4% with stenting and 4.7% with endarterectomy (hazard ratio, 1.50; P=0.03); the rates among symptomatic patients were 8.0% and 6.4% (hazard ratio, 1.37; P=0.14), and the rates among asymptomatic patients were 4.5% and 2.7% (hazard ratio, 1.86; P=0.07), respectively. Periprocedural rates of individual components of the end points differed between the stenting group and the endarterectomy group: for death (0.7% vs. 0.3%, P=0.18), for stroke (4.1% vs. 2.3%, P=0.01), and for myocardial infarction (1.1% vs. 2.3%, P=0.03). After this period, the incidences of ipsilateral stroke with stenting and with endarterectomy were similarly low (2.0% and 2.4%, respectively; P=0.85). Among patients with symptomatic or asymptomatic carotid stenosis, the risk of the composite primary outcome of stroke, myocardial infarction, or death did not differ significantly in the group undergoing carotid-artery stenting and the group undergoing carotid endarterectomy. During the periprocedural period, there was a higher risk of stroke with stenting and a higher risk of myocardial infarction with endarterectomy. (ClinicalTrials.gov number, NCT00004732.)