Carotid Artery Stenting Versus Endarterectomy for Stroke Prevention A Meta-Analysis of Clinical Trials
Carotid Artery Stenting Versus Endarterectomy for Stroke Prevention A Meta-Analysis of Clinical Trials
复制标题
DOI：
10.1016/j.jacc.2017.02.053
复制
发表时间：
2017-05-09
影响因子：
24
通讯作者：
Giri, Jay
中科院分区：
文献类型：
--
作者：
Sardar, Partha;Chatterjee, Saurav;Giri, Jay
关于颈动脉支架植入术（CAS）和颈动脉内膜切除术（CEA）预防颈动脉狭窄所致卒中的相对有效性的数据冲突。结论作者进行了一项更新的荟萃分析，根据最近发表的临床试验数据，评估CAS与CEA的有效性和安全性。选择了随机试验，患者≥ 50例，仅使用防栓塞装置，并比较CAS与CEA治疗颈动脉狭窄。我们使用随机效应模型计算了总体优势比（OR）和95%置信区间（CI）。结果我们分析了来自5项试验的6,526例患者，平均随访时间为5.3年。围手术期死亡、卒中、心肌梗死（MI）或非围手术期同侧卒中的复合结局在两种治疗之间无显著差异（OR：1.22; 95% CI：0.94 - 1.59）。CAS组任何围手术期卒中加非围手术期同侧卒中的风险较高（OR：1.50; 95% CI：1.22 - 1.84）。CAS组卒中风险较高主要归因于围手术期轻微卒中（OR：2.43; 95% CI：1.71 - 3.46）。CAS与围手术期MI风险显著降低相关（OR：0.45; 95% CI：0.27 - 0.75）;颅神经麻痹（OR：0.07; 95% CI：0.04 - 0.14）;围手术期死亡、卒中、MI或颅神经麻痹的复合结局结论CAS和CEA与围手术期死亡、卒中、MI或非围手术期同侧卒中的复合发生率相似。CAS组的长期总体卒中风险显著较高，主要归因于围手术期轻微卒中。与CEA相比，CAS与围手术期MI和颅神经麻痹的发生率较低相关。(C)2017年美国心脏病学院基金会。
BACKGROUND Data conflict regarding the relative effectiveness of carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) for the prevention of stroke due to carotid artery stenosis.OBJECTIVES The authors performed an updated meta-analysis evaluating the efficacy and safety of CAS versus CEA, given recently published clinical trial data.METHODS Databases were searched through April 30, 2016. Randomized trials with >= 50 patients, that had exclusive use of embolic-protection devices, and that compared CAS against CEA for the treatment of carotid artery stenosis were selected. We calculated summary odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model.RESULTS We analyzed 6,526 patients from 5 trials with a mean follow-up of 5.3 years. The composite outcome of periprocedural death, stroke, myocardial infarction (MI), or nonperiprocedural ipsilateral stroke was not significantly different between therapies (OR: 1.22; 95% CI: 0.94 to 1.59). The risk of any periprocedural stroke plus nonperiprocedural ipsilateral stroke was higher with CAS (OR: 1.50; 95% CI: 1.22 to 1.84). The risk of higher stroke with CAS was mostly attributed to periprocedural minor stroke (OR: 2.43; 95% CI: 1.71 to 3.46). CAS was associated with significantly lower risk of periprocedural MI (OR: 0.45; 95% CI: 0.27 to 0.75); cranial nerve palsy (OR: 0.07; 95% CI: 0.04 to 0.14); and the composite outcome of death, stroke, MI, or cranial nerve palsy during the periprocedural period (OR: 0.75; 95% CI: 0.60 to 0.93).CONCLUSIONS CAS and CEA were associated with similar rates of a composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke. The risk of long-term overall stroke was significantly higher with CAS, and was mostly attributed to periprocedural minor stroke. CAS was associated with lower rates of periprocedural MI and cranial nerve palsy than CEA. (C) 2017 by the American College of Cardiology Foundation.