Short-Term Outcomes of Carotid Artery Stenting versus Carotid Endarterectomy in the Treatment of Carotid Stenosis: An Up-Dated Meta-Analysis of Randomized Controlled Trials

İzzet Aydemir; İhsan Doğan; Afsun Ezel Esatoğlu

Makale detayları

Short-Term Outcomes of Carotid Artery Stenting versus Carotid Endarterectomy in the Treatment of Carotid Stenosis: An Up-Dated Meta-Analysis of Randomized Controlled Trials

Yazarlar:

İzzet Aydemir | İhsan Doğan | Afsun Ezel Esatoğlu

Yayıncı:

Duzce University

Ana Başlıklar:

Clinical Sciences

Dergi:

Duzce Medical Journal Vol.25 Issue 3, pp.242-250

Belge Tipi:

Makale

Yayın Tarihi:

12/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297973

pISSN:

1307-671X

Anahtar kelimeler:

Özet:

 Aim: Carotid artery stenting is thought to result in better outcomes when compared to carotid endarterectomy. To evaluate this hypothesis, a far-reaching of published randomized controlled trials were performed to evaluate the short-term outcomes of carotid artery stenting versus carotid endarterectomy for patients undergoing carotid artery stenosis. Material and Methods: A comprehensive search of trials published from 1994 until December 31, 2022, was performed using Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus, and Cochrane Central electronic databases. Major endpoints any stroke, myocardial infarction, and all-cause mortality were extracted from the publications. Pooled risk ratio RR and 95 confidence interval CI were calculated using a fixed-effects model. Results: 21 trials involving 15518 patients 8514 with stenting, 7004 with endarterectomy were included in the meta-analysis. Stenting was associated with a significantly increased risk of short-term any stroke RR1.555, 95 CI: 1.307-1.851, p0.001 yet a significantly decreased risk of short-term myocardial infarction RR0.458, 95 CI: 0.319-0.660, p0.001 when compared with endarterectomy. No significant difference was found in all-cause mortality between the two interventions RR1.277, 95 CI: 0.835-1.952, p0.259, but with a trend toward superiority favoring endarterectomy. Conclusion: Endarterectomy was found to be superior in terms of any stroke and partially regarding all-cause mortality, whereas stenting was found to be superior in terms of myocardial infarction. Yet for robust results, further studies are needed to address the relative effectiveness of stenting versus endarterectomy in the future.

 Aim: Carotid artery stenting is thought to result in better outcomes when compared to carotid endarterectomy. To evaluate this hypothesis, a far-reaching of published randomized controlled trials were performed to evaluate the short-term outcomes of carotid artery stenting versus carotid endarterectomy for patients undergoing carotid artery stenosis. Material and Methods: A comprehensive search of trials published from 1994 until December 31, 2022, was performed using Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus, and Cochrane Central electronic databases. Major endpoints any stroke, myocardial infarction, and all-cause mortality were extracted from the publications. Pooled risk ratio RR and 95 confidence interval CI were calculated using a fixed-effects model. Results: 21 trials involving 15518 patients 8514 with stenting, 7004 with endarterectomy were included in the meta-analysis. Stenting was associated with a significantly increased risk of short-term any stroke RR1.555, 95 CI: 1.307-1.851, p0.001 yet a significantly decreased risk of short-term myocardial infarction RR0.458, 95 CI: 0.319-0.660, p0.001 when compared with endarterectomy. No significant difference was found in all-cause mortality between the two interventions RR1.277, 95 CI: 0.835-1.952, p0.259, but with a trend toward superiority favoring endarterectomy. Conclusion: Endarterectomy was found to be superior in terms of any stroke and partially regarding all-cause mortality, whereas stenting was found to be superior in terms of myocardial infarction. Yet for robust results, further studies are needed to address the relative effectiveness of stenting versus endarterectomy in the future.

 Aim: Carotid artery stenting is thought to result in better outcomes when compared to carotid endarterectomy. To evaluate this hypothesis, a far-reaching of published randomized controlled trials were performed to evaluate the short-term outcomes of carotid artery stenting versus carotid endarterectomy for patients undergoing carotid artery stenosis. Material and Methods: A comprehensive search of trials published from 1994 until December 31, 2022, was performed using Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus, and Cochrane Central electronic databases. Major endpoints any stroke, myocardial infarction, and all-cause mortality were extracted from the publications. Pooled risk ratio RR and 95 confidence interval CI were calculated using a fixed-effects model. Results: 21 trials involving 15518 patients 8514 with stenting, 7004 with endarterectomy were included in the meta-analysis. Stenting was associated with a significantly increased risk of short-term any stroke RR1.555, 95 CI: 1.307-1.851, p0.001 yet a significantly decreased risk of short-term myocardial infarction RR0.458, 95 CI: 0.319-0.660, p0.001 when compared with endarterectomy. No significant difference was found in all-cause mortality between the two interventions RR1.277, 95 CI: 0.835-1.952, p0.259, but with a trend toward superiority favoring endarterectomy. Conclusion: Endarterectomy was found to be superior in terms of any stroke and partially regarding all-cause mortality, whereas stenting was found to be superior in terms of myocardial infarction. Yet for robust results, further studies are needed to address the relative effectiveness of stenting versus endarterectomy in the future.

 Amaç: Karotis arter stentlemenin karotis endarterektomiye kıyasla daha iyi sonuçlar ürettiği düşünülmektedir. Bu hipotezi sınamak için, karotis arter stenozu geçiren hastalarda karotis arter stentleme ve karotis endarterektominin kısa süreli sonuçlarını değerlendirmek üzere yayınlanmış randomize kontrollü çalışmaların geniş kapsamlı değerlendirmesi yapıldı. Gereç ve Yöntemler: Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus ve Cochrane Central elektronik veri tabanları kullanılarak 1994ten 31 Aralık 2022ye kadar yayınlanmış olan denemelerin kapsamlı bir araştırması yapıldı. Yayınlardan temel sonlanım noktaları herhangi bir inme türü, miyokard enfarktüsü ve tüm nedenlere bağlı ölüm çıkarıldı. Sabit etkiler modeli iler etki büyüklüğü risk oranı RO ve 95 güven aralığı GA hesaplandı. Bulgular: Bu meta-analizine 15518 hastayı 8514 stentleme, 7004 endarterektomi içeren 21 çalışma dahil edildi. Endarterektomi ile karşılaştırıldığında, stentleme, kısa süreli herhangi bir inme riskinde anlamlı derecede artma RR1,555; 95 GA: 1,307-1,851; p0,001, ancak kısa süreli miyokard enfarktüsü riskinde ise azalma RR0,458; 95 GA: 0,319-0,660; p0,001 ile ilişkiliydi. İki müdahale arasında tüm nedenlere bağlı ölüm açısından anlamlı bir fark yokken RR1,277; 95 GA: 0,835-1,952; p0,259 endarterektomi lehine üstünlük eğilimi vardı. Sonuç: Endarterektominin herhangi bir inme türü açısından ve kısmen de tüm nedenlere bağlı ölüm açısından üstün olduğu, stentlemenin ise miyokard enfarktüsü açısından üstün olduğu görüldü. Ancak daha sağlam sonuçlar için gelecekte stentlemenin endarterektomiye karşı göreceli etkinliğini ele alan daha fazla çalışmalara ihtiyaç vardır.

Makale detayları

Short-Term Outcomes of Carotid Artery Stenting versus Carotid Endarterectomy in the Treatment of Carotid Stenosis: An Up-Dated Meta-Analysis of Randomized Controlled Trials

Yazarlar:

İzzet Aydemir | İhsan Doğan | Afsun Ezel Esatoğlu

Yayıncı:

Duzce University

Ana Başlıklar:

Clinical Sciences

Dergi:

Duzce Medical Journal Vol.25 Issue 3, pp.242-250

Belge Tipi:

Makale

Yayın Tarihi:

12/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297973

pISSN:

1307-671X

Carotid endarterectomy

meta-analysis

randomized controlled trial

short-terms outcomes

carotid artery stentingKarotis endarterektomi

meta-analizi

randomize kontrollü çalışmalar

kısa-dönem sonuçlar

karotis arter stentleme

Sayı

Makale detayları

Yazarlar: İzzet Aydemir | İhsan Doğan | Afsun Ezel Esatoğlu

Yayıncı: Duzce University

Ana Başlıklar: Clinical Sciences

Dergi: Duzce Medical Journal Vol.25 Issue 3, pp.242-250

Belge Tipi: Makale

Yayın Tarihi: 12/2023

Belge Dili: İngilizce

Document ID (Org No.): 2001297973

pISSN: 1307-671X

Sayı

Yazarlar:

İzzet Aydemir | İhsan Doğan | Afsun Ezel Esatoğlu

Yayıncı:

Duzce University

Ana Başlıklar:

Clinical Sciences

Dergi:

Duzce Medical Journal Vol.25 Issue 3, pp.242-250

Belge Tipi:

Makale

Yayın Tarihi:

12/2023

Belge Dili:

İngilizce

Document ID (Org No.):

2001297973

pISSN:

1307-671X