University of Michigan Cardiovascular Center, Floor 2A 394, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
BMJ. 2010 Feb 12;340:c467. doi: 10.1136/bmj.c467.
To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting.
Systematic review and meta-analysis.
BIOSIS, Embase, Medline, the Cochrane central register of controlled trials, International Pharmaceutical Abstracts database, ISI Web of Science, and Google scholar and bibliographies, from 1 January 1990 to 25 July 2009.
Randomised controlled trials comparing carotid endarterectomy with carotid artery stenting in patients with carotid artery stenosis with or without symptoms.
Primary end point was a composite of mortality or stroke. Secondary end points were death, stroke, myocardial infarction, or facial neuropathy (as individual end points), and mortality or disabling stroke (as a composite end point).
11 trials were included (4796 patients); 10 reported on short term outcomes (n=4709) and nine on intermediate term outcomes (1-4 years). The periprocedural risk of mortality or stroke was lower for carotid endarterectomy (odds ratio 0.67, 95% confidence interval 0.47 to 0.95; P=0.025) than for carotid stenting, mainly because of a decreased risk of stroke (0.65, 0.43 to 1.00; P=0.049), whereas the risk of death (1.14, 0.56 to 2.31; P=0.727) and the composite end point mortality or disabling stroke (0.74, 0.53 to 1.05; P=0.088) did not differ significantly. The odds of periprocedural myocardial infarction (2.69, 1.06 to 6.79; P=0.036) or cranial nerve injury (10.2, 4.0 to 26.1; P<0.001) was higher in the carotid endarterectomy group than in the carotid stenting group. In the intermediate term, the two treatments did not differ significantly for stroke or death (hazard ratio 0.90, 95% confidence interval 0.74 to 1.1; P=0.314).
Carotid endarterectomy was found to be superior to carotid artery stenting for short term outcomes but the difference was not significant for intermediate term outcomes; this difference was mainly driven by non-disabling stroke. Significantly fewer cranial nerve injuries and myocardial infarctions occurred with carotid artery stenting.
评估颈动脉内膜切除术与颈动脉支架置入术治疗颈动脉狭窄的相对短期安全性和中期疗效。
系统评价和荟萃分析。
BIOSIS、Embase、Medline、Cochrane 对照试验中心注册库、国际药学文摘数据库、ISI Web of Science 和 Google 学术及参考文献，检索时间为 1990 年 1 月 1 日至 2009 年 7 月 25 日。
比较颈动脉内膜切除术与颈动脉支架置入术治疗有或无症状颈动脉狭窄患者的随机对照试验。
主要终点是死亡率或卒中性复合终点。次要终点为死亡、卒 中、心肌梗死或面部神经病（作为单个终点）以及死亡率或致残性卒 中（作为复合终点）。
共纳入 11 项试验（4796 例患者）；10 项研究报告了短期结果（n=4709），9 项研究报告了中期结果（1~4 年）。颈动脉内膜切除术的围手术期死亡率或卒中性复合终点的风险低于颈动脉支架置入术（比值比 0.67，95%置信区间 0.47 至 0.95；P=0.025），主要是因为卒中风险降低（0.65，0.43 至 1.00；P=0.049），而死亡率（1.14，0.56 至 2.31；P=0.727）和复合终点死亡率或致残性卒 中（0.74，0.53 至 1.05；P=0.088）差异无统计学意义。颈动脉内膜切除术组围手术期心肌梗死（2.69，1.06 至 6.79；P=0.036）或颅神经损伤（10.2，4.0 至 26.1；P<0.001）的发生率高于颈动脉支架置入术组。中期时，两种治疗方法在卒中和死亡方面差异无统计学意义（危险比 0.90，95%置信区间 0.74 至 1.1；P=0.314）。
颈动脉内膜切除术在短期结果方面优于颈动脉支架置入术，但中期结果差异无统计学意义；这种差异主要是由非致残性卒 中驱动的。颈动脉支架置入术组颅神经损伤和心肌梗死发生率明显较低。
