*Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands †Department of Vascular and Endovascular Surgery, Beth Israel Medical Center, Boston, MA ‡Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands §Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands; and ¶Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
Ann Surg. 2015 Mar;261(3):598-604. doi: 10.1097/SLA.0000000000000799.
To study perioperative results and restenosis during follow-up of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for restenosis after prior ipsilateral CEA in an individual patient data (IPD) meta-analysis.
The optimal treatment strategy for patients with restenosis after CEA remains unknown.
A comprehensive search of electronic databases (Medline, Embase) until July 1, 2013, was performed, supplemented by a review of references. Studies were considered for inclusion if they reported procedural outcome of CAS or CEA after prior ipsilateral CEA of a minimum of 5 patients. IPD were combined into 1 data set and an IPD meta-analysis was performed. The primary endpoint was perioperative stroke or death and the secondary endpoint was restenosis greater than 50% during follow-up, comparing CAS and CEA.
In total, 13 studies were included, contributing to 1132 unique patients treated by CAS (10 studies, n = 653) or CEA (7 studies; n = 479). Among CAS and CEA patients, 30% versus 40% were symptomatic, respectively (P < 0.01). After adjusting for potential confounders, the primary endpoint did not differ between CAS and CEA groups (2.3% vs 2.7%, adjusted odds ratio 0.8, 95% confidence interval (CI): 0.4-1.8). Also, the risk of restenosis during a median follow-up of 13 months was similar for both groups (hazard ratio 1.4, 95% (CI): 0.9-2.2). Cranial nerve injury (CNI) was 5.5% in the CEA group, while CAS was in 5% associated with other procedural related complications.
In patients with restenosis after CEA, CAS and CEA showed similar low rates of stroke, death, and restenosis at short-term follow-up. Still, the risk of CNI and other procedure-related complications should be taken into account.
通过个体患者数据（IPD）荟萃分析，研究颈动脉支架置入术（CAS）与颈动脉内膜切除术（CEA）治疗同侧 CEA 后再狭窄患者的围手术期结果和再狭窄情况。
对于 CEA 后再狭窄患者，最佳治疗策略仍不清楚。
对电子数据库（Medline、Embase）进行全面检索，检索截至 2013 年 7 月 1 日，补充查阅参考文献。如果研究报告了至少 5 例同侧 CEA 后 CAS 或 CEA 的手术结果，则将其纳入研究。将 IPD 合并为一个数据集，并进行 IPD 荟萃分析。主要终点为围手术期卒中或死亡，次要终点为随访期间再狭窄>50%，比较 CAS 和 CEA 的结果。
共纳入 13 项研究，涉及 1132 例接受 CAS（10 项研究，n=653）或 CEA（7 项研究，n=479）治疗的患者。在 CAS 和 CEA 患者中，分别有 30%和 40%为症状性（P<0.01）。调整潜在混杂因素后，CAS 和 CEA 组的主要终点无差异（2.3%比 2.7%，调整比值比 0.8，95%置信区间[CI]：0.4-1.8）。此外，两组在中位随访 13 个月期间的再狭窄风险相似（风险比 1.4，95%CI：0.9-2.2）。CEA 组颅神经损伤（CNI）发生率为 5.5%，而 CAS 组与其他手术相关并发症相关的发生率为 5%。
在 CEA 后再狭窄患者中，CAS 和 CEA 在短期随访时显示出相似的低卒中、死亡率和再狭窄率。然而，应考虑 CNI 和其他手术相关并发症的风险。
