Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis.
Carotid artery stenting versus carotid endarterectomy in the treatment of symptomatic and asymptomatic carotid stenosis: a systematic review and meta-analysis.
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颈动脉支架置入术与颈动脉内膜切除术治疗有症状和无症状颈动脉狭窄：系统评价和荟萃分析
DOI：
10.19779/j.cnki.2096-3602.2018.01.09
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发表时间：
2018-03
影响因子：
--
通讯作者：
Zheng C
中科院分区：
文献类型：
--
作者：
Kan X;Wang Y;Xiong B;Liang B;Zhou G;Liang H;Zheng C
目的：评价颈动脉支架置入术(CAS)与颈动脉内膜剥脱术(CEA)的近期、中远期疗效和安全性。材料和方法：应用计算机检索已发表的文献，检索2000年1月至2017年1月在CAS和CEA治疗颈动脉狭窄中进行的随机对照试验。对短期和中长期结果进行评估。结果：我们确定了10个RCT，其中包括7183名有症状或无症状的颈动脉狭窄的参与者。我们的荟萃分析发现，有症状的患者和没有症状的患者的结果不同。在有症状性颈动脉狭窄的患者中，在围手术期30天内，颈动脉组的总卒中发生率显著高于颈动脉组(p<；0.001)，而心肌梗死的发生率显著低于颈动脉组(p<；0.05)。两组患者术后30d内病死率差异无统计学意义，但CAS组中远期卒中或死亡发生率高于CEA组(P<；0.05)。相比之下，对于无症状的患者，CAS组和CEA组在短期和中长期结果方面没有显著差异。结论：对于有症状的颈动脉狭窄患者，CEA与心肌梗死风险增加相关，而CAS与程序性卒中风险增加相关。然而，对于无症状的颈动脉狭窄患者，CAS和CEA在疗效和安全性方面没有显著差异。
Purpose: To evaluate the short-term and intermediate- to long-term efficacy and safety of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA). Materials and Methods: The published literature was electronically searched for randomized controlled trials (RCTs) between CAS and CEA for the treatment of carotid stenosis performed from January 2000 to January 2017. The short-term and intermediate- to long-term outcomes were evaluated. Results: We identified 10 RCTs including 7,183 participants with symptomatic or asymptomatic carotid stenosis. Our meta-analysis found different results between the patients with and those without symptoms. In patients with symptomatic carotid stenosis, the total stroke incidence in the CAS group was significantly higher than that in the CEA group within the 30-day periprocedural period (p<0.001); however, the myocardial infarction incidence in the CAS group was significantly lower than that in the CEA group (p<0.05). There was no significant difference between the two groups in the mortality within 30 days post-procedure, but the intermediate- to long-term incidence of stroke or death in the CAS group was higher than that of the CEA group (p<0.05). In contrast, for asymptomatic patients, there were no significant differences between the CAS and CEA groups in the short- and intermediate- to long-term outcomes. Conclusion: For patients with symptomatic carotid stenosis, CEA is associated with an increased risk of myocardial infarction, whereas CAS is correlated with an increased risk of procedurally related strokes. However, for patients with asymptomatic carotid stenosis, no significant difference was found in the efficacy or safety between CAS and CEA.