Antonopoulos Constantine N, Giosdekos Alexandros, Mylonas Spyridon N, Liapis Christos D
Athens Vascular Research Center, Athens, Greece.
Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
Ann Transl Med. 2020 Oct;8(19):1263. doi: 10.21037/atm.2020.03.148.
Near occlusion of internal carotid artery (ICA) is a rare and easily misdiagnosed condition and the decision for revascularisation still remains controversial. We conducted an updated meta-analysis in order to investigate outcomes after carotid endarterectomy (CEA), carotid artery stenting (CAS) or best medical treatment (BMT) in patients with near-occlusion of the ICA. We also aimed to investigate the role of time as a potential moderator of the near-ICA occlusion-stroke rate association. A multiple electronic health database search on articles published up to November 2019 was performed. The pooled stroke rate after CEA, CAS and BMT were calculated. We also investigated transient ischemic attack (TIA), stroke-related death, myocardial infarction (MI), any cause of death and ICA restenosis crude rates (%). A total of 33 articles were finally deemed eligible. The pooled stroke rate was 1.52% [95% confidence interval (CI): 0.09-4.02%] after CEA, 1.80% (95% CI: 0.61-3.40%) after CAS and 8.39% (95% CI: 3.39-14.80%) after BMT. Out of 896 CEA patients, we recorded 22 TIAs (2.5%), 33 all-cause deaths (3.7%), 5 stroke-related deaths (0.6%) and 6 MIs (0.7%). Concerning outcomes after 603 CAS patients, we recorded 7 TIAs (1.2%), 56 all-cause deaths (9.3%), 4 stroke-related deaths (0.7%) and 22 MIs (3.6%). Among 263 patients who were treated with BMT, we found 16 TIAs (6.1%), 10 all-cause deaths (3.8%), no stroke-related death, and no MI. Crude restenosis rate during follow-up was 9.0% (54/601) for CEA and 4.1% (24/592) for CAS patients. No significant effect of publication year upon stroke rate after CEA was recorded. However, there was a significant reversed association between pooled stroke rate after CAS and publication year (P=0.05). A statistically significant reversed association between pooled stroke rate after BMT and publication year was also recorded (P<0.01). The results of this updated meta-analysis revealed high stroke rate for patients with near-occlusion of ICA who treated only with BMT, while intervention seemed to be safe and effective. A downward trend in the stroke rates over time after CAS and BMT was also discovered. These highlight that patients with near-occlusion of ICA should be included and investigated in future studies.
颈内动脉（ICA）近乎闭塞是一种罕见且易被误诊的病症，而血管重建术的决策仍存在争议。我们进行了一项最新的荟萃分析，以研究颈内动脉近乎闭塞患者接受颈动脉内膜切除术（CEA）、颈动脉支架置入术（CAS）或最佳药物治疗（BMT）后的结局。我们还旨在研究时间作为颈内动脉近乎闭塞与卒中发生率关联的潜在调节因素的作用。我们对截至2019年11月发表的文章进行了多个电子健康数据库搜索。计算了CEA、CAS和BMT后的汇总卒中发生率。我们还调查了短暂性脑缺血发作（TIA）、卒中相关死亡、心肌梗死（MI）、任何原因导致的死亡以及ICA再狭窄的粗发生率（%）。最终共有33篇文章被认为符合条件。CEA后的汇总卒中发生率为1.52%[95%置信区间（CI）：0.09 - 4.02%]，CAS后为1.80%（95%CI：0.61 - 3.40%），BMT后为8.39%（95%CI：3.39 - 14.80%）。在896例CEA患者中，我们记录到22例TIA（2.5%）、33例全因死亡（3.7%）、5例卒中相关死亡（0.6%）和6例MI（0.7%）。关于603例CAS患者的结局，我们记录到7例TIA（1.2%）、56例全因死亡（9.3%）、4例卒中相关死亡（0.7%）和22例MI（3.6%）。在263例接受BMT治疗的患者中，我们发现16例TIA（6.1%）、10例全因死亡（3.8%），无卒中相关死亡，也无MI。CEA患者随访期间的再狭窄粗发生率为9.0%（54/601），CAS患者为4.1%（24/592）。未记录到发表年份对CEA后卒中发生率有显著影响。然而，CAS后的汇总卒中发生率与发表年份之间存在显著的反向关联（P = 0.05）。还记录到BMT后的汇总卒中发生率与发表年份之间存在统计学显著的反向关联（P < 0.01）。这项最新荟萃分析的结果显示，仅接受BMT治疗的颈内动脉近乎闭塞患者卒中发生率较高，而干预似乎是安全有效的。还发现CAS和BMT后卒中发生率随时间呈下降趋势。这些结果突出表明，颈内动脉近乎闭塞患者应纳入未来研究并进行调查。
