Meta-Analysis of Randomized Controlled Trials Comparing the Long-Term Outcomes of Carotid Artery Stenting Versus Endarterectomy

For those of you with partially blocked arteries. My right carotid is completely blocked and the left one is clear. It's all good because obviously my Circle of Willis is complete.
http://circoutcomes.ahajournals.org/content/8/6_suppl_3/S99.abstract?etoc

1. Sophie Vincent,
2. Maria Eberg, MSc,
3. Mark J. Eisenberg, MD, MPH and
4. Kristian B. Filion, PhD

+ Author Affiliations

1. From the Center for Clinical Epidemiology, Lady Davis Institute (S.V., M.E., M.J.E., K.B.F.) and Division of Cardiology (M.J.E.), Jewish General Hospital, Montreal, Quebec, Canada; and Faculty of Medicine (S.V., M.J.E., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), Division of Cardiology (M.J.E.), and Division of Clinical Epidemiology, Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada.

1. Correspondence to Kristian B. Filion, PhD, Division of Clinical Epidemiology, Jewish General Hospital, McGill University, 3755 Cote Ste-Catherine Rd, Suite H416.1, Montreal, Quebec, Canada. E-mail kristian.filion@mcgill.ca

Abstract

Background—Stenting is an endovascular alternative to endarterectomy for the management of carotid stenosis, but its long-term safety and efficacy relative to endarterectomy remain unclear. Our objective was to compare the safety and efficacy of stenting with those of endarterectomy, with a particular focus on long-term outcomes, via meta-analysis of randomized controlled trials (RCTs).

Methods and Results—We systematically searched PubMed, EMBASE, MEDLINE, and the Cochrane Library for RCTs with ≥50 patients that compared stenting with endarterectomy in patients with carotid stenosis. Periprocedural and long-term outcomes were assessed, with data pooled across RCTs using random-effects models. Eight RCTs were included in our meta-analysis (n=7091), with follow-up ranging from 2.0 to 10.0 years. When compared with endarterectomy, stenting was associated with an increased risk of periprocedural stroke (relative risk, 1.49, 95% confidence interval [CI], 1.11 to 2.01; risk difference, 1.7%; 95% CI, 0.3 to 3.0) but a decreased risk of periprocedural myocardial infarction (relative risk, 0.47; 95% CI, 0.29 to 0.78; risk difference, −0.4%; 95% CI, −0.8% to 0.1%). During long-term follow-up, stenting was associated with an increased risk of stroke (relative risk, 1.36; 95% CI, 1.16 to 1.61) and a composite end point of ipsilateral stroke, periprocedural stroke, or periprocedural death (relative risk, 1.45; 95% CI, 1.20 to 1.75).

Conclusions—Although stenting has more favorable periprocedural outcomes with respect to myocardial infarction, the observed increased risk of stroke and death throughout follow-up with stenting suggests that endarterectomy remains the treatment of choice for carotid stenosis.