Better long-term outcomes in carotid endarterectomy than in stenting
Carotid endarterectomy yields better short- and long-term outcomes than stenting for carotid artery stenosis, according to a new meta-analysis. However, endarterectomy is also associated with higher risks of periprocedural myocardial infarction.
Pooled data from eight trials (n=7,005) showed significantly lower risks of periprocedural myocardial infarction in patients who underwent stenting (odds ratio [OR], 0.52; 95 percent CI, 0.33 to 0.81; p=0.004).
On the other hand, the incidence of the composite outcome of death or stroke was significantly higher in stenting than in endarterectomy (OR, 1.76; 1.38 to 2.25; p<0.0001). Minor stroke (OR, 2.19; 1.59 to 3.01; p<0.0001) accounted for majority of this association; incidence major strokes (OR, 1.41; 0.95 to 2.09; p=0.09) and deaths (OR, 1.68; 0.82 to 3.44; p=0.16) were not significantly elevated.
Pooled data from seven trials (n=6,799) showed that long-term stroke was significantly more common in stenting than in endarterectomy (OR, 1.45; 1.22 to 1.73; p<0.0001). The long-term risk of the composite outcome of death, ipsilateral stroke and periprocedural stroke was significantly higher in stenting (OR, 1.25; 1.05 to 1.48; p=0.01).
On the other hand, there were no significant differences between the two groups in terms of ipsilateral stroke (OR, 1.04; 0.79 to 1.37; p=0.80) and long-term all-cause mortality (OR, 1.09; 0.95 to 1.26; p=0.21). All but one of the trials showed low risk of bias.
The meta-analysis included randomized controlled trials that compared the efficacy and safety of endarterectomy with stenting. Exclusion criteria included retrospective and observational study designs, and a follow-up period <4 years.
The databases of Embase, PubMed and the Cochrane Library Central Register of Controlled Trials were accessed. Risk of bias was determined using the Cochrane Collaboration guidelines.