For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
35
views
56
references
 Top references
cited by
13
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      381
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Systematic Review and Meta-Analysis of Carotid Artery Stenting Versus Endarterectomy for Carotid Stenosis : A Chronological and Worldwide Study

      review-article
      Author(s): , MD, , MD, , MD, , MD, , MD, , MD, , MD, , MD
      Editor(s):
      Publication date (Electronic):
      Journal: Medicine
      Publisher: Lippincott Williams & Wilkins

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          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.

          Related collections

          Most cited references56

          • Record: found
          • Abstract: found
          • Article: not found

          Protected carotid-artery stenting versus endarterectomy in high-risk patients.

          Jay S Yadav, Mark Wholey, Richard Kuntz … (2004)
          Carotid endarterectomy is more effective than medical management in the prevention of stroke in patients with severe symptomatic or asymptomatic atherosclerotic carotid-artery stenosis. Stenting with the use of an emboli-protection device is a less invasive revascularization strategy than endarterectomy in carotid-artery disease. We conducted a randomized trial comparing carotid-artery stenting with the use of an emboli-protection device to endarterectomy in 334 patients with coexisting conditions that potentially increased the risk posed by endarterectomy and who had either a symptomatic carotid-artery stenosis of at least 50 percent of the luminal diameter or an asymptomatic stenosis of at least 80 percent. The primary end point of the study was the cumulative incidence of a major cardiovascular event at 1 year--a composite of death, stroke, or myocardial infarction within 30 days after the intervention or death or ipsilateral stroke between 31 days and 1 year. The study was designed to test the hypothesis that the less invasive strategy, stenting, was not inferior to endarterectomy. The primary end point occurred in 20 patients randomly assigned to undergo carotid-artery stenting with an emboli-protection device (cumulative incidence, 12.2 percent) and in 32 patients randomly assigned to undergo endarterectomy (cumulative incidence, 20.1 percent; absolute difference, -7.9 percentage points; 95 percent confidence interval, -16.4 to 0.7 percentage points; P=0.004 for noninferiority, and P=0.053 for superiority). At one year, carotid revascularization was repeated in fewer patients who had received stents than in those who had undergone endarterectomy (cumulative incidence, 0.6 percent vs. 4.3 percent; P=0.04). Among patients with severe carotid-artery stenosis and coexisting conditions, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy. Copyright 2004 Massachusetts Medical Society.
          Article 0 comments Cited 263 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Ischemic stroke subtypes: a population-based study of incidence and risk factors.

            J P Whisnant, David K Brown, B G Petty … (1999)
            There is scant population-based information on incidence and risk factors for ischemic stroke subtypes. We identified all 454 residents of Rochester, Minn, with a first ischemic stroke between 1985 and 1989 from the Rochester Epidemiology Project medical records linkage system. We used Stroke Data Bank criteria to assign infarct subtypes after reviewing medical records and brain imaging. We adjusted average annual incidence rates by age and sex to the US 1990 population and compared the age-adjusted frequency of stroke risk factors across ischemic stroke subtypes. Age- and sex-adjusted incidence rates (per 100 000 population) were as follows: large-vessel cervical or intracranial atherosclerosis with >50% stenosis, 27; cardioembolic, 40; lacuna, 25; uncertain cause, 52; other or uncommon cause, 4. Sex differences in incidence rates were detected only for atherosclerosis with stenosis (47 [95% CI, 34 to 61] for men; 12 [95% CI, 7 to 17] for women). There was no difference in prior transient ischemic attack and hypertension among subtypes, and diabetes was not more common among patients with lacunar infarction than other common subtypes. The age-adjusted incidence rate of stroke due to stenosis of the large cervicocephalic vessels is nearly 4 times higher for men than for women. There is no association between preceding transient ischemic attack and stroke mechanism. Diabetes and hypertension are not more common among patients with lacunae. Age- and sex-adjusted incidence rates for ischemic stroke subtypes in this population can be compared with similarly determined rates from other populations.
            Article 0 comments Cited 101 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Long-term results of carotid stenting versus endarterectomy in high-risk patients.

              Donald E Cutlip, Gary Ansel, Myron S Cohen … (2008)
              We previously reported that, in a randomized trial, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy for the treatment of carotid artery disease at 30 days and at 1 year. We now report the 3-year results. The trial evaluated carotid artery stenting with the use of an emboli-protection device as compared with endarterectomy in 334 patients at increased risk for complications from endarterectomy who had either a symptomatic carotid artery stenosis of at least 50% of the luminal diameter or an asymptomatic stenosis of at least 80%. The prespecified major secondary end point at 3 years was a composite of death, stroke, or myocardial infarction within 30 days after the procedure or death or ipsilateral stroke between 31 days and 1080 days (3 years). At 3 years, data were available for 260 patients (77.8%), including 85.6% of patients in the stenting group and 70.1% of those in the endarterectomy group. The prespecified major secondary end point occurred in 41 patients in the stenting group (cumulative incidence, 24.6%; Kaplan-Meier estimate, 26.2%) and 45 patients in the endarterectomy group (cumulative incidence, 26.9%; Kaplan-Meier estimate, 30.3%) (absolute difference in cumulative incidence for the stenting group, -2.3%; 95% confidence interval, -11.8 to 7.0). There were 15 strokes in each of the two groups, of which 11 in the stenting group and 9 in the endarterectomy group were ipsilateral. In our trial of patients with severe carotid artery stenosis and increased surgical risk, no significant difference could be shown in long-term outcomes between patients who underwent carotid artery stenting with an emboli-protection device and those who underwent endarterectomy. (ClinicalTrials.gov number, NCT00231270 [ClinicalTrials.gov].). Copyright 2008 Massachusetts Medical Society.
              Article 0 comments Cited 98 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Lippincott Williams & Wilkins
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: July 2015
                Publication date (Electronic): 02 July 2015
                Volume: 94
                Issue: 26
                Electronic Location Identifier: e1060
                Affiliations
                From the Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (LZ, ZZ, YO, JB, QL, RF, ZJ); and Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (JZ).
                Author notes
                Correspondence: Zaiping Jing, Department of Vascular Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China (e-mail: xueguanky@ 123456163.com ).
                Jian Zhou, Department of Surgery, Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China (e-mail: zhoujian1-2@ 123456163.com ).
                Article
                Accession ID: 01060
                DOI: 10.1097/MD.0000000000001060
                PMC ID: 4504641
                PubMed ID: 26131824
                SO-VID: 976873d3-e2a0-43f4-8f2b-041906f9523f
                Copyright © Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
                License:

                This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0

                History
                Date received : 30 April 2015
                Date received : 30 May 2015
                Date accepted : 2 June 2015
                Categories
                Subject: 3400
                Subject: Research Article
                Subject: Systematic Reviewand Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Data availability:

                Comments

                Comment on this article

                scite_

                Similar content381

                See all similar

                Cited by13

                See all cited by

                Most referenced authors1,767

                See all reference authors