Abstract
Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities. Methods: A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis. Results: In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77–1.25; I2 = 0%), myocardial ischemic events (OR 1.03; 0.72–1.48; I2 = 0%) and all events (OR 1.0; 0.82–1.21; I2 = 0%). Pooled stroke incidence in asymptomatic patients was 1% (95% CI: 0–2%) for CEA and 1% for CAS (95% CI: 0–2%). Pooled stroke rate in symptomatic patients was 3% (95% CI: 1–4%) for CEA and 3% (95% CI: 1–4%) for CAS. The two techniques did not differ in either outcome both in asymptomatic and symptomatic patients. Conclusion: Carotid revascularization, performed in centers providing both CAS and CEA, is safe and effective. Both techniques did not differ in terms of post-procedural neurological and cardiac events, both in asymptomatic and symptomatic patients. These findings reiterate the importance of a tailored therapeutic strategy and that “real-world” outcomes may only be valid from centers providing both treatments.
Highlights
Introduction published maps and institutional affilAs stroke is one of the main disabling and fatal causes in the developed world, carotid atherosclerosis management enforces its role in daily clinical practice [1,2]
Current guidelines recommend carotid endarterectomy (CEA) as the standard treatment in symptomatic and asymptomatic patients, while carotid artery stenting (CAS) is suggested as an alternative approach in high-risk patients with adverse medical co-morbidities or anatomical restrictions [1]
The risk of peri-procedural events, including stroke, myocardial infarction (MI) and death, is reasonable to consider in the decision making
Summary
As stroke is one of the main disabling and fatal causes in the developed world, carotid atherosclerosis management enforces its role in daily clinical practice [1,2]. The beneficial role of carotid endarterectomy (CEA) in preventing stroke, mostly to symptomatic and to a lesser extent to asymptomatic patients, has been well established [1]. In the era of less invasive procedures, carotid artery stenting (CAS) has emerged as an alternative therapeutic modality. Current guidelines recommend CEA as the standard treatment in symptomatic and asymptomatic patients, while CAS is suggested as an alternative approach in high-risk patients with adverse medical co-morbidities or anatomical restrictions [1]. The risk of peri-procedural events, including stroke, myocardial infarction (MI) and death, is reasonable to consider in the decision making.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
