Key result
Carotid artery stenting increases 30-day stroke or death ~51% compared to endarterectomy.
Why the study?
There are disparities among results of meta-analyses comparing carotid artery stenting and endarterectomy for carotid stenosis under different circumstances.
Does carotid artery stenting reduce stroke or death compared to carotid endarterectomy in patients with carotid stenosis?
Meta-Analysis (n=27,525)
Yes
Does carotid artery stenting reduce stroke or death compared to carotid endarterectomy in patients with carotid stenosis?
Relative Risk: 1.51 (95% CI 1.32–1.74)
p-value: p=<0.001
Carotid endarterectomy is superior to carotid artery stenting for reducing the risk of stroke or death within 30 days, as well as at 4 and 10 years, in patients with carotid stenosis.
CEA preferred over CAS to minimize periprocedural stroke/death; extends prior meta-analyses via temporal and geographic stratification.
There are disparities among the results of meta-analyses under different circumstances of carotid artery stenting (CAS) versus endarterectomy (CEA) for carotid stenosis. This study aimed to assess the efficacies of CAS and CEA for carotid stenosis at 5-year intervals and worldwide.Comparative studies simultaneously reporting CAS and CEA for carotid stenosis with at least 10 patients in each group were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles.The studies were stratified into different subgroups according to the publication year, location in which the study was mainly performed, and randomized and nonrandomized study designs.Thirty-five comparative studies encompassing 27,525 patients were identified. The risk ratios (RRs) of stroke/death when CAS was compared with CEA within 30 d of treatment were 1.51 (95% CI 1.32-1.74, P < 0.001) for overall, 1.50 (95% CI 1.14-1.98, P = 0.004) from 2011 to 2015, 1.61 (95% CI 1.35-1.91, P < 0.001) from 2006 to 2010, 1.59 (95% CI 1.27-1.99, P < 0.001) in North America, 1.50 (95% CI 1.24-1.81, P < 0.001) in Europe, 1.63 (95% CI 1.31-2.02, P < 0.001) for randomized, and 1.44 (95% CI 1.20-1.73, P < 0.001) for nonrandomized comparative studies. CEA decreased the risks of transient ischemic attack at 30 d (RR: 2.07, 95% CI 1.50-2.85, P < 0.001) and restenosis at 1-year (RR: 1.97, 95% CI 1.28-3.05, P = 0.002). Data from follow-up showed that the RRs of stroke/death were 0.74 (95% CI 0.55-0.99, P = 0.04) at 1 year, 1.24 (95% CI 1.04-1.46, P = 0.01) at 4 year, and 2.27 (95% CI 1.39-3.71, P = 0.001) at 10 year. This systematic review, compared with those of other meta-analyses, included all available comparative studies and analyzed them at 5-year intervals, in different continents, and under different study designs. Current evidence suggests that the efficacy of CEA is superior to CAS for freedom from stroke/death within 30 d, especially from 2006 to 2015, in North America and Europe. Meanwhile, the superiority was also observed for restenosis at 1-year, transient ischemic attack within 30 d, and stroke/death at 4- and 10-year follow-ups.
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Zhang et al. (2015) conducted a meta-analysis in Carotid stenosis (n=27,525). Carotid artery stenting vs. Carotid endarterectomy was evaluated on Stroke or death within 30 days of treatment (RR 1.51, 95% CI 1.32-1.74, p=<0.001). Carotid artery stenting was associated with a higher risk of stroke or death within 30 days compared to endarterectomy (RR 1.51; 95% CI 1.32-1.74; P<0.001).
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