China International Neuroscience Institute (China-INI), Peoples Republic of China (J.W., X.B., T.W., L.J.).
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Peoples Republic of China (J.W., X.B., T.W., L.J.).
Stroke. 2022 Oct;53(10):3047-3054. doi: 10.1161/STROKEAHA.122.038994. Epub 2022 Jun 22.
To compare safety and efficacy between carotid artery stenting (CAS) and carotid endarterectomy (CEA) in treating asymptomatic carotid artery stenosis based on results from randomized controlled trials.
Randomized controlled trials comparing CAS and CEA in treating asymptomatic carotid artery stenosis were searched from databases of the EMBASE, PubMed, MEDLINE, and Cochrane libraries. Two independent reviewers identified eligible studies, extracted relevant data, and used the Cochrane risk of bias tool to assess quality. Mantel-Haenszel method random-effects models were used to estimate odds ratio (OR) regarding perioperative risks between CAS and CEA. Kaplan-Meier curve data were extracted and analyzed through Exp[(O-E)/Var] fixed-effect models to calculate the Peto odds ratio (OR) regarding long-term outcomes.
Sixteen articles from 7 randomized controlled trials were included, reporting relevant outcomes for 7230 asymptomatic carotid artery stenosis patients (CAS: n=3920; CEA: n=3198). Compared with the CEA group, CAS group had no difference in perioperative composite end point events including stroke, death, and myocardial infarction (MI; OR, 1.13 [95% CI, 0.87-1.47]; =0.37, I=0%). Compared with CEA, CAS had a higher risk of any stroke during the perioperative period (OR, 1.62 [95% CI, 1.16-2.24]; =0.004, I=0%) and an increased risk of nondisabling stroke (OR, 1.81 [95% CI, 1.23-2.65]; =0.003, I=0%), but there was no significant difference in disabling stroke and death between groups (OR, 0.91 [95% CI, 0.50-1.65]; =0.76, I=0%). For long-term outcomes, no difference regarding the composite outcome of any stroke, death, and myocardial infarction existed between CEA and CAS (Peto OR, 1.18 [95% CI, 0.94-1.48]; =0.14, I=0%). Individual-level patient data would be important to verify the long-term outcome results.
When treating asymptomatic carotid artery stenosis, CAS has comparable perioperative and long-term composite outcomes compared with CEA. However, CAS may have a higher risk of any stroke and nondisabling stroke in the perioperative period.
为了比较颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）治疗无症状颈动脉狭窄的安全性和有效性，我们基于随机对照试验的结果进行了研究。
我们从 EMBASE、PubMed、MEDLINE 和 Cochrane 图书馆的数据库中检索了比较 CAS 和 CEA 治疗无症状颈动脉狭窄的随机对照试验。两位独立的审查员确定了合格的研究，提取了相关数据，并使用 Cochrane 偏倚风险工具评估了质量。Mantel-Haenszel 方法随机效应模型用于估计 CAS 和 CEA 围手术期风险的比值比（OR）。提取 Kaplan-Meier 曲线数据，并通过 Exp[(O-E)/Var]固定效应模型进行分析，以计算长期结果的 Peto 比值比（OR）。
纳入了 7 项随机对照试验的 16 篇文章，报告了 7230 例无症状颈动脉狭窄患者的相关结局（CAS 组：n=3920；CEA 组：n=3198）。与 CEA 组相比，CAS 组围手术期复合终点事件（包括卒中和死亡）发生率无差异（OR，1.13 [95% CI，0.87-1.47]；=0.37，I²=0%）。与 CEA 相比，CAS 术中有更高的围手术期任何卒中风险（OR，1.62 [95% CI，1.16-2.24]；=0.004，I²=0%）和更高的非致残性卒中风险（OR，1.81 [95% CI，1.23-2.65]；=0.003，I²=0%），但两组之间致残性卒中和死亡风险无差异（OR，0.91 [95% CI，0.50-1.65]；=0.76，I²=0%）。对于长期结局，CEA 和 CAS 之间的任何卒中和死亡的复合结局没有差异（Peto OR，1.18 [95% CI，0.94-1.48]；=0.14，I²=0%）。个体水平的患者数据对于验证长期结局结果很重要。
在治疗无症状颈动脉狭窄时，CAS 的围手术期和长期复合结局与 CEA 相当。然而，CAS 在围手术期可能有更高的任何卒中和非致残性卒中风险。
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