Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA.
401 General Military Hospital, Athens, Greece.
World Neurosurg. 2019 Jun;126:656-663.e1. doi: 10.1016/j.wneu.2019.02.030. Epub 2019 Feb 22.
Results from studies comparing carotid artery endarterectomy (CEA) with carotid artery stenting (CAS) in the elderly population are variable in the literature. The objective of this study was to investigate whether CEA or CAS is associated with a better safety profile in older adults (>80 years of age) for treatment of symptomatic and asymptomatic stenosis.
A random-effects meta-analysis was performed, and the I statistic was used to assess heterogeneity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses were performed as needed.
Nine studies comprising 5955 patients were included in this meta-analysis. No differences were identified in terms of 30-day stroke (CEA: 5.8% [n = 257/4415]; CAS: 10.5% [n = 81/767]; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.30-1.08; I = 26.1%), myocardial infarction (MI) (CEA: 1.1% [n = 4/357]; CAS: 0.5% [n = 2/355]; OR, 1.67; 95% CI, 0.37-7.46; I = 0%), transient ischemic attack (TIA) (CEA: 0% [n = 0/98]; CAS: 4.2% [n = 7/166]; OR, 0.28; 95% CI, 0.03-2.52; I = 0%), death (CEA: 1.5% [n = 8/523]; CAS: 0.9% [n = 4/431]; OR, 1.41; 95% CI, 0.43-4.58; I = 0%), and cranial nerve injury (CEA: 5.8% [n = 3/51]; CAS: 0% [n = 0/51]; OR, 4.74; 95% CI, 0.5-44.98; I =0%). A subgroup comparing CEA with transfemoral protected CAS showed that patients in the CEA group had a statistically significant lower risk of 30-day stroke (OR, 0.31; 95% CI, 0.17-0.57; I = 30.8%).
This study shows that CEA is associated with a statistically significant lower risk of 30-day stroke in the elderly population compared with transfemoral CAS with distal or proximal protection. No differences were noted in the rates of periprocedural TIA, MI, death, and cranial nerve injury between CEA and CAS in the original pooled analysis.
比较颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）在老年人群中的研究结果在文献中存在差异。本研究旨在探讨在治疗有症状和无症状狭窄的老年患者（>80 岁）中，CEA 或 CAS 是否具有更好的安全性。
采用随机效应荟萃分析，根据系统评价和荟萃分析的 Preferred Reporting Items 指南使用 I ² 统计量评估异质性。根据需要进行亚组分析。
本荟萃分析纳入了 9 项研究，共 5955 例患者。30 天内卒中方面，CEA 组为 5.8%（n=257/4415），CAS 组为 10.5%（n=81/767），优势比（OR）为 0.57（95%置信区间[CI]，0.30-1.08）；I²=26.1%）；心肌梗死（MI）方面，CEA 组为 1.1%（n=4/357），CAS 组为 0.5%（n=2/355），OR 为 1.67（95%CI，0.37-7.46）；I²=0%）；短暂性脑缺血发作（TIA）方面，CEA 组为 0%（n=0/98），CAS 组为 4.2%（n=7/166），OR 为 0.28（95%CI，0.03-2.52）；I²=0%）；死亡方面，CEA 组为 1.5%（n=8/523），CAS 组为 0.9%（n=4/431），OR 为 1.41（95%CI，0.43-4.58）；I²=0%）；颅神经损伤方面，CEA 组为 5.8%（n=3/51），CAS 组为 0%（n=0/51），OR 为 4.74（95%CI，0.5-44.98）；I²=0%）。一项比较 CEA 与经股动脉保护的 CAS 的亚组分析显示，CEA 组 30 天内卒中风险显著降低（OR，0.31；95%CI，0.17-0.57；I²=30.8%）。
本研究表明，与经股动脉有或无远端近端保护的 CAS 相比，CEA 与老年人群中 30 天内卒中风险降低具有统计学意义。在原始汇总分析中，CEA 和 CAS 在围手术期 TIA、MI、死亡和颅神经损伤方面的发生率无差异。
