Gao Xinyi, Guo Julong, Pan Dikang, Gu Yongquan
Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing , China.
Oper Neurosurg. 2025 Jan 1;28(1):19-28. doi: 10.1227/ons.0000000000001251. Epub 2024 Jul 5.
To compare the safety and efficacy of carotid endarterectomy (CEA), carotid stenting (CAS), and optimal medical therapy (OMT) in patients with asymptomatic carotid stenosis.
Relevant randomized controlled trials were researched with PubMed, Web of Science, and the Cochrane Library databases. Fixed-effects model and random-effects model were used to estimate the relative risks and the hazard ratios (HRs). The results of the probabilistic analysis were reported as surfaces under the cumulative ranking curve.
Eight randomized controlled trials were included. Data from 10 348 patients (CEA: n = 4758; CAS: n = 3919; OMT: n = 1673) were evaluated. Compared with the previous OMT, CEA, CAS, and the current OMT (c-OMT) were all effective in reducing the risk of stroke (CEA: HR, 0.52; CI, 0.40-0.66; CAS: HR, 0.58; CI, 0.42-0.81; c-OMT: HR, 0.40; CI, 0.15-0.94); CEA and CAS reduced the risk of ipsilateral stroke (CEA: HR, 0.41; CI, 0.28-0.59; CAS: HR, 0.51; CI, 0.31-0.84), and the risk of fatal or disabling stroke (CEA: HR, 0.59; CI, 0.43-0.81; CAS: HR, 0.57; CI, 0.34-0.95). Regarding reducing the risk of stroke, only CEA was statistically significant in patients with any degree of stenosis compared with the previous medical treatment (<80%: HR, 0.48; CI, 0.33%-0.70%; 80%-99%: HR, 0.53; CI, 0.38-0.73).
In the treatment of asymptomatic carotid stenosis, the perioperative outcomes of CAS were similar to that of CEA; CEA, CAS, and c-OMT shared similar long-term outcomes; and CEA and CAS may be more effective in patients with high levels of asymptomatic stenosis.
比较颈动脉内膜切除术（CEA）、颈动脉支架置入术（CAS）和最佳药物治疗（OMT）在无症状性颈动脉狭窄患者中的安全性和有效性。
通过PubMed、Web of Science和Cochrane图书馆数据库检索相关随机对照试验。采用固定效应模型和随机效应模型估计相对风险和风险比（HRs）。概率分析结果以累积排名曲线下的面积表示。
纳入8项随机对照试验。评估了10348例患者的数据（CEA：n = 4758；CAS：n = 3919；OMT：n = 1673）。与既往OMT相比，CEA、CAS和当前OMT（c-OMT）均能有效降低卒中风险（CEA：HR，0.52；CI，0.40 - 0.66；CAS：HR，0.58；CI，0.42 - 0.81；c-OMT：HR，0.40；CI，0.15 - 0.94）；CEA和CAS降低了同侧卒中风险（CEA：HR，0.41；CI，0.28 - 0.59；CAS：HR，0.51；CI，0.31 - 0.84）以及致命或致残性卒中风险（CEA：HR，0.59；CI，0.43 - 0.81；CAS：HR，0.57；CI，0.34 - 0.95）。在降低卒中风险方面，与既往药物治疗相比，仅CEA在任何程度狭窄的患者中具有统计学意义（<80%：HR，0.48；CI，0.33% - 0.70%；80% - 99%：HR，0.53；CI，0.38 - 0.73）。
在无症状性颈动脉狭窄的治疗中，CAS的围手术期结果与CEA相似；CEA、CAS和c-OMT的长期结果相似；CEA和CAS在无症状性高度狭窄患者中可能更有效。
