Han Yanshuo, Zhang Jian, Wu Xiaoyu, Jiang Han, Gang Qingwei, Shen Shikai, Xin Shijie, Duan Zhiquan
Department of Vascular Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, China.
Department of Vascular Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, China. Email:
Zhonghua Yi Xue Za Zhi. 2014 Feb 25;94(7):510-6.
To evaluate the medium-long term effectiveness of eversion (eCEA) and conventional (cCEA) carotid endarterectomy on carotid artery stenosis.
We searched MEDLINE (1970-2012.12), Ovid (1970-2012), CBM (1970-2012.12) and CNKI (1970-2012.12) database. Relevant journals and dissertation were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed through software STATA 11.2.
A total of 21 studies were deemed eligible (8 617 eCEA and 7 830 cCEA procedures), six of which were randomized and 14 non-randomized. Base on 15 121 patients underwent carotid artery stenosis including 16 447 cases, eCEA was association with a shorter mean operation time (WMD -85.00 min, P < 0.001), internal carotid artery clamp time (WMD -3.9 min, P < 0.01) and less shunt usage (OR = 0.20, P < 0.01). Furthermore, eCEA was associated with significant reduction in 30-day mortality (OR = 0.59, P = 0.013), perioperative stroke (OR = 0.63, P = 0.044), residual restenosis (OR = 0.51, P = 0.019) and carotid artery occlusion (OR = 0.44, P = 0.001). Although eCEA did not reduce medium-long term all-caused mortality (OR = 0.81, P = 0.143) during follow-up time, eCEA presented with a significant reduction in late residual restenosis (OR = 0.34, P < 0.01) and carotid artery occlusion (OR = 0.30, P < 0.01). A sub-analysis was performed on studies directly comparing eCEA with patch CEA (CEA+P), eCEA replicated the finding on perioperative stroke, 30-day mortality, and stroke-related death within short term and late residual restenosis. Concerning outcomes of RCT, eCEA presents with a significant reduction in the residual restenosis (OR = 0.43, 95%CI: 0.27, 0.69, P < 0.01) and carotid artery occlusion (OR = 0.11, 95%CI: 0.02, 0.62, P = 0.012) during following-up time.
Eversion CEA compared to conventional CEA may be associated with a short operation time and a short block time. eCEA appears to be associated with better 30-day mortality and stroke outcome than cCEA. Eversion CEA may be more effective for long-term prevention of restenosis, however, in the long term, it is not associated with a reduction in all-cause mortality.
评估外翻式颈动脉内膜切除术（eCEA）和传统颈动脉内膜切除术（cCEA）治疗颈动脉狭窄的中长期疗效。
检索MEDLINE（1970 - 2012年12月）、Ovid（1970 - 2012年）、中国生物医学文献数据库（CBM，1970 - 2012年12月）和中国知网（CNKI，1970 - 2012年12月）数据库。同时手工检索相关期刊和学位论文。两名评价者根据《Cochrane系统评价干预措施手册》独立进行研究选择与评估、数据收集和分析。通过STATA 11.2软件进行Meta分析。
共纳入21项研究（eCEA手术8617例，cCEA手术7830例），其中6项为随机对照研究，14项为非随机对照研究。基于15121例接受颈动脉狭窄手术的患者（共16447例病例），eCEA组的平均手术时间较短（加权均数差[WMD] - 85.00分钟，P < 0.001），颈内动脉阻断时间较短（WMD - 3.9分钟，P < 0.01），分流使用较少（比值比[OR] = 0.20，P < 0.01）。此外，eCEA组30天死亡率（OR = 0.59，P = 0.013）、围手术期卒中（OR = 0.63，P = 0.044）、残余再狭窄（OR = 0.51，P = 0.019）和颈动脉闭塞（OR = 0.44，P = 0.001）均显著降低。虽然eCEA在随访期间未降低中长期全因死亡率（OR = 0.81，P = 0.143），但eCEA组晚期残余再狭窄（OR = 0.34，P < 0.01）和颈动脉闭塞（OR = 0.30，P < 0.01）显著降低。对直接比较eCEA与补片CEA（CEA + P）的研究进行亚组分析，eCEA在围手术期卒中、30天死亡率以及短期和晚期残余再狭窄的卒中相关死亡方面重复了上述结果。关于随机对照试验的结果，eCEA在随访期间残余再狭窄（OR = 0.43，95%置信区间[CI]：0.27，0.69，P < 0.01）和颈动脉闭塞（OR = 0.11，95%CI：0.02，0.62，P = 0.012）显著降低。
与传统CEA相比，外翻式CEA可能手术时间和阻断时间较短。eCEA在30天死亡率和卒中结局方面似乎优于cCEA。外翻式CEA在长期预防再狭窄方面可能更有效，然而，从长期来看，它与全因死亡率降低无关。
