Department of Vascular and Endovascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
The Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.
Eur J Vasc Endovasc Surg. 2018 Apr;55(4):465-473. doi: 10.1016/j.ejvs.2017.12.025. Epub 2018 Feb 14.
A 2011 meta-analysis comparing eversion (eCEA) with conventional (cCEA) carotid endarterectomy in 16,251 patients concluded that eCEA was associated with lower rates of peri-operative stroke and late occlusion compared with cCEA. However, randomised controlled trials (RCTs) showed no difference in outcomes. Since then, the literature contains outcome data on 49,500 patients undergoing eCEA or cCEA. An updated meta-analysis was performed to establish whether eCEA confers significant benefit over cCEA.
This was a systematic review of PubMed/Medline, Embase, and Cochrane databases for RCTs and observational studies (OSs) comparing eCEA with cCEA. A sensitivity analysis was also performed using data from OSs with a Newcastle-Ottawa score >5.
There were 25 eligible studies (5 RCTs, 20 OSs) involving 49,500 CEAs (16,249 eCEAs; 33,251 cCEAs). RCT data: Compared with cCEA, eCEA did not confer significant reductions in 30 day stroke, death, death/stroke, death/stroke/MI, or neck haematoma. However, eCEA was associated with reduced late restenosis (OR 0.40; p = .001). OS data: eCEA was associated with significant reductions in 30 day death (OR 0.46; p < .0001), stroke (OR 0.58; p < .0001), death/stroke (OR 0.52; p < .0001), death/stroke/MI (OR 0.50; p < .0001), and late restenosis (OR 0.49; p = .032) compared with cCEA. RCT and OS data combined: eCEA was associated with significant reductions in 30 day death (OR 0.55; p < .0001), stroke (OR 0.63; p = .004), death/stroke (OR 0.58; p < .0001), and late restenosis (OR 0.45; p = .004) compared with cCEA. eCEA vs. patched cCEA (RCT and OS data): There were no differences between the two procedures except for neck haematoma, where eCEA was better than patched cCEA.
Using combined RCT and OS data, eCEA was superior to cCEA regarding peri-operative outcomes (stroke, death, death/stroke) and late restenosis, but was similar to patched CEA in both early and late outcomes. This updated meta-analysis suggests that early and late outcomes following cCEA are similar to eCEA, provided the arteriotomy is patched.
2011 年的一项荟萃分析比较了 16251 例外翻（eCEA）与传统（cCEA）颈动脉内膜切除术患者，得出的结论是 eCEA 与 cCEA 相比，围手术期卒中发生率和晚期闭塞率较低。然而，随机对照试验（RCT）显示结局没有差异。此后，文献中包含了 49500 例接受 eCEA 或 cCEA 治疗的患者的结局数据。进行了一项更新的荟萃分析，以确定 eCEA 是否优于 cCEA。
这是对 PubMed/Medline、Embase 和 Cochrane 数据库中 RCT 和比较 eCEA 与 cCEA 的观察性研究（OS）的系统评价。还使用 Newcastle-Ottawa 评分>5 的 OS 数据进行了敏感性分析。
共有 25 项符合条件的研究（5 项 RCT、20 项 OS）涉及 49500 例颈动脉内膜切除术（16249 例 eCEA；33251 例 cCEA）。RCT 数据：与 cCEA 相比，eCEA 并不能显著降低 30 天卒中、死亡、死亡/卒中、死亡/卒中/心肌梗死或颈部血肿的发生率。然而，eCEA 与晚期再狭窄减少相关（OR 0.40；p=0.001）。OS 数据：eCEA 与 30 天死亡（OR 0.46；p<0.0001）、卒中（OR 0.58；p<0.0001）、死亡/卒中（OR 0.52；p<0.0001）、死亡/卒中/心肌梗死（OR 0.50；p<0.0001）和晚期再狭窄（OR 0.49；p=0.032）的发生率显著降低相关与 cCEA。RCT 和 OS 数据合并：与 cCEA 相比，eCEA 与 30 天死亡（OR 0.55；p<0.0001）、卒中（OR 0.63；p=0.004）、死亡/卒中（OR 0.58；p<0.0001）和晚期再狭窄（OR 0.45；p=0.004）的发生率显著降低。eCEA 与 patched cCEA（RCT 和 OS 数据）：两种手术之间除颈部血肿外无差异，eCEA 优于 patched cCEA。
使用合并的 RCT 和 OS 数据，eCEA 在围手术期结局（卒中、死亡、死亡/卒中）和晚期再狭窄方面优于 cCEA，但在早期和晚期结局方面与 patched CEA 相似。这项更新的荟萃分析表明，cCEA 后的早期和晚期结局与 eCEA 相似，前提是动脉切开术被修补。
