Abstract WMP88: Endovascular Versus Medical Treatment For Chronic Occlusion Of The Internal Carotid Artery: Systematic Review And Meta-analysis

Abstract

Introduction: Chronic occlusion of the ICA (COICA) is an important cause of ischemic strokes. Evidence has showed that medical management (MM) alone is not sufficient for prevention of ischemic events. Carotid occlusion endovascular revascularization & stenting (COERS) is a promising technique, yet its safety and superiority to MM remain unclear. Objective: To pool and compare rates of safety and efficacy outcomes of COERS versus MM of COICA. Methods: We conducted a systematic search in Embase, Medline, and Web of Science for studies reporting short and long-term outcomes of symptomatic COICA patients who received MM and/or COERS. Main efficacy outcomes were successful recanalization and long-term recurrence of ischemic events. Safety outcomes for COERS were periprocedural (<30 days) events. We performed a meta-analysis of proportions for MM and COERS groups, using GLMM transformation and a random-effects model. Results: 11 studies contained data of COICA patients undergoing COERS, 3 studies of patients who received only MM, and 2 studies compared both arms; they provided data for 513 and 313 patients in the COERS and MM groups, respectively. The pooled recanalization rate after treatment with COERS was 75% (95% CI 0.67-0.82, PI 0.49-0.94, I 2 64%). Recurrence rates of ischemic events at long-term follow-up were 19% (95% CI 0.15-0.25, PI 0.11-0.32, I 2 25%) with MM, and 11% (95% CI 0.07-0.19, PI 0.02-0.42, I 2 2%) after COERS; comparison meta-analysis showed a similar non-significant trend (MM:24% vs. COERS:13%, OR 0.52, 95% CI 0.17-1.59, I 2 0%). The rate of periprocedural events in the COERS group were 2.3% (95% CI 0.012-0.045, I 2 0%) for stroke/TIA, and 2.1% (95% CI 0.011-0.038, I 2 0%) for any ICH. Conclusion: COERS is a feasible technique and a safe strategy for maximizing secondary stroke prevention for the treatment of symptomatic COICA. Still, further prospective trials to better define safety and efficacy boundaries are needed before starting a RCT.