Department of Anesthesiology, University of Montreal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2011 Dec;25(6):1024-9. doi: 10.1053/j.jvca.2011.01.009. Epub 2011 Mar 12.
To compare carotid artery stenting with open carotid surgery for the treatment of symptomatic or asymptomatic carotid artery stenosis in terms of stroke, myocardial infarction, and death at 30 days.
A meta-analysis of parallel randomized clinical trials (RCTs) (blind or open) published (full article available) in English.
University-based electronic search.
Patients were submitted to carotid artery stenting or open carotid artery surgery.
Ten RCTs including 6,950 patients were found. There was a moderate amount of heterogeneity (I(2) = 49.8%) in stroke at 30 days when all available data were added together. Heterogeneity fell to 0% when only studies (n = 4) in which cerebral protection devices were used in a high percentage of the patients in the stenting groups were retained. Those 4 studies included 5,012 patients. Carotid endarterectomy reduced the risk ratio (RR) of stroke at 30 days compared with stenting (RR = 0.50; 95% confidence interval (CI), 0.38-0.67; p = 0.000002; event rate 2.8% and 5.6%). Carotid endarterectomy increases the risk of myocardial infarction (RR = 2.16 [95% CI, 1.32-3.54], p = 0.002, heterogeneity 0%, event rate 1.8% and 0.9%). There was no difference in death at 30 days (RR = 0.72 [0.42-1.24] (random effects model), p = 0.23, I(2) = 2.45%, p value for heterogeneity = 0.41; event rate 0.7% and 1.1% for carotid endarterectomy and stenting, respectively).
Compared with stenting, carotid endarterectomy decreases the risk of stroke at 30 days, increases the risk of myocardial infarction, and does not affect the risk of death.
比较颈动脉支架置入术与颈动脉内膜切除术治疗症状性或无症状性颈动脉狭窄在 30 天内的卒中、心肌梗死和死亡。
对发表的（可获得全文）平行随机临床试验（RCT）（盲法或开放）进行的荟萃分析。
以大学为基础的电子搜索。
患者接受颈动脉支架置入术或颈动脉内膜切除术。
共发现 10 项 RCT，包括 6950 例患者。当所有可用数据合并在一起时，30 天内卒中存在中度异质性（I²=49.8%）。当仅保留支架组中使用脑保护装置的患者比例较高的 4 项研究（n=5012 例）时，异质性降为 0%。与支架置入术相比，颈动脉内膜切除术降低了 30 天内卒中的风险比（RR）（RR=0.50；95%置信区间[CI]，0.38-0.67；p=0.000002；事件发生率为 2.8%和 5.6%）。颈动脉内膜切除术增加了心肌梗死的风险（RR=2.16[95%CI，1.32-3.54]，p=0.002，异质性 0%，事件发生率为 1.8%和 0.9%）。30 天内死亡率无差异（RR=0.72[0.42-1.24]（随机效应模型），p=0.23，I²=2.45%，p 值为异质性=0.41；事件发生率分别为颈动脉内膜切除术和支架置入术的 0.7%和 1.1%）。
与支架置入术相比，颈动脉内膜切除术降低了 30 天内卒中的风险，增加了心肌梗死的风险，但不影响死亡风险。
