Carotid artery stenting or carotid endarterectomy for treatment of carotid stenosis: Effectiveness and safety

doi:10.3969/j.issn.2095-4344.2013.51.022

Abstract

Abstract:

BACKGROUND: Large randomized trials have demonstrated carotid endarterectomy or stenting for symptomatic and asymptomatic extracranial carotid stenosis is effective.
OBJECTIVE: Using the meta analysis method, to evaluate efficacy and safety of carotid stenting and carotid endarterectomy for the treatment of carotid stenosis.
METHODS: Computer-based retrieval of databases both at home and abroad was performed for randomized controlled trials related to carotid stenting and carotid endarterectomy for the treatment of carotid stenosis. According to exclusion criteria, literature screening was done followed by quality evaluation. Then, the enrolled literatures were analyzed by Cochrane collaboration with RevMan5.0 Meta analysis software.
RESULTS AND CONCLUSION: There were 14 enrolled studies, including 7 693 patients among whom, 3 835 cases were in stenting group and 3 858 in carotid endarterectomy group. Compared with the carotid endarterectomy group, the stroke event rate within 30 days postoperatively, death and stroke event rate within 30 days postoperatively, myocardial infarction event rate within 1 year postoperatively and non-disabling stroke event rate within 30 days postoperatively were higher in the stenting group (P ≤0.000 1); the myocardial infarction event rate within 30 days postoperatively was lower in the stenting group (P=0.001 0). There were no significant differences in the death event rate and disabled stroke event rate within 30 days postoperatively between the two groups. These two treatments are complementary rather than antagonistic. We should optimize the treatment choice based on the comprehensive analysis of each patient's condition.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, carotid stenosis, stents, endarterectomy, carotid

CLC Number:

R318

Xin Hai, Bai Chao, Wang Yang, Li Xin-xi, Luo Jun, Tian Ye, Zhang Ke-rui. Carotid artery stenting or carotid endarterectomy for treatment of carotid stenosis: Effectiveness and safety[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(51): 8920-8927.

Figures/Tables 6

支架植入组和颈动脉内膜剥脱组之间无统计学异质性(P=0.53，I2=0)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示支架植入组高于颈动脉内膜剥脱组(OR=1.73，95%CI= 1.31-2.28，P=0.000 1)。 2.3.2 术后30 d内死亡事件纳入的文献中共有13篇比较了术后30 d死亡事件的发生率[1-2,4-9,10-14]，见图3。支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.52，I2=0)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示两组差异无显著性意义(OR=1.35，95%CI=0.82-2.22，P=0.23)。 2.2.3 术后30 d内死亡和脑卒中事件纳入的文献中共有13篇比较了术后30 d死亡与脑卒中事件的发生率[1-8,10-14]，见图4。颈动脉支架植入和颈动脉内膜剥脱治疗颈动脉狭窄30 d脑卒中与死亡事件发生率的比较支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.17，I2=29%)，采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示：支架植入组高于颈动脉内膜剥脱组(OR=1.59，95%CI=1.29-1.97，P < 0.000 1)。 2.2.4 术后30 d与1年内心肌梗死事件术后30 d心肌梗死事件：纳入的文献中共有10篇比较了术后30 d心肌梗死事件的发生率[1-6, 8, 11-14]，见图5。支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.95，I2=0)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示支架植入组低于颈动脉内膜剥脱组(OR=0.45，95%CI=0.28-0.72，P=0.001 0)。术后1年心肌梗死事件：纳入的文献中共有4篇比较了术后1年心肌梗死事件的发生率[2, 7-8, 10]，见图6。支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.37，I2=0)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示支架植入组高于颈动脉内膜剥脱组(OR=2.62，95%CI=1.74-3.94，P < 0.000 01)。 2.2.5 术后30 d非致残性脑卒中与致残性脑卒中事件术后30 d非致死性脑卒中事件发生率：纳入的文献中共有9篇比较了术后30 d非致残性脑卒中事件的发生率[1-2, 4-7, 10, 12-13]，见图7。支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.18，I2=33%)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示支架植入组高于颈动脉内膜剥脱组(OR=1.87，95%CI=1.39-2.51，P < 0.000 1)。术后30 d致残性脑卒中事件：纳入的文献中共有9篇比较了术后30 d致残性脑卒中事件的发生率[1-2, 4-7, 10, 12-13]，见图8。支架植入组和颈动脉内膜剥脱组之间无异质性(P=0.38，I2=6%)，故采用固定效应模型对两组数据进行统计学合并与比较。Meta 分析结果显示两组差异无显著性意义(OR=1.21，95%CI=0.84-1.74，P=0.30)。"

References

[1]Brooks WH,McClure RR,Jones MR,et al.Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital.J Am Coll Cardiol.2001;38(6): 1589- 1595.

[2]CAVATAS investigators.Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS):a randomised trial.Lancet.2001;357(2):1729-1737.

[3]Alberts MJ.Results of a Multicenter Prospective Randomized Trial of Carotid Artery Stenting vs.Carotid Endarterectomy. Stroke.2001;32(1):325-d.

[4]Brooks WH,McClure RR,Jones MR,et al.Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital.Neurosurgery.2003;54(2):318-325.

[5]Yadav JS,Wholey MH,Kuntz RE,et al.Protected carotid-artery stenting versus endarterectomy in high-risk patients.N EnglJ Med.2004;315(15):1493-1501.

[6]Mas JL,Chatellier G,Beyssen B,et al.Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N EnglJ Med.2006;355(16):1660-1671.

[7]SPACE Collaborative Group,Ringleb PA,Allenberg J,et al.30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients:a randomised non-inferiority trial.Lancet.2006; 368 (7):1239-1247.

[8]凌峰,焦力群.颈动脉内膜剥脱术与支架成形术对颈动脉粥样硬化性狭窄治疗的初步研究[J].中国脑血管病杂志,2006,3(1):4-8.

[9]Steinbauer MG,Pfister K,Greindl M,et al.Alert for increased long-term follow-up after carotid artery stenting: Results of a prospective,randomized, single-center trial of carotid artery stenting vs carotid endarterectomy.J Vasc Surg.2008;48(1): 93-98.

[10]Eckstein HH,Ringleb P,Allenberg JR,et al.Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective,randomised trial.Lancet.2008; 7(10): 893-902.

[11]刘昌伟,刘暴,叶炜,等.颈动脉内膜剥脱术和颈动脉支架的前瞻性随机对照研究[J].中华外科杂志,2009,47(4):267-270.

[12]International Carotid Stenting Study investigators,Ederle J,Dobson J,et al.Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.Lancet.2010;375(9719):985-997.

[13]Brott TG,Hobson RW 2nd,Howard G,et al.Stenting versus endarterectomy for treatment of carotid-artery stenosis.N Engl J Med.2010;363(1):11-23.

[14]刘建林,杨林,马强,等.颈动脉内膜切除与支架置入治疗症状性颈动脉狭窄的疗效比较[J].中华神经外科杂志,2012,28(4): 382-385.

[15]Gahremanpour A,Perin EC,Silva G.Carotid artery stenting versus endarterectomy: a systematic review.Tex Heart Inst J.2012;39(4):474-487.

[16]Naylor AR,Bolia A,Abbott RJ,et al.Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: A stopped trial,J Vasc Surg.1998;28: 326-334.

[17]刘昌伟.颈动脉内膜剥脱术和颈动脉支架的客观评述[J].临床外科杂志,2009,17(5):291-292.

[18]张勤奕.颈动脉内膜剥脱术与颈动脉支架成形术的优劣比较[J].中华老年心脑血管病杂志,2009,11(9):651-652.

[19]缪中荣.颈动脉狭窄的血管成形和支架置入术[J].中华脑血管病杂志:电子版,2007,1(1):41-44.

[20]苏克江.颈动脉狭窄患者的卒中预防内膜切除术,支架置入血管成形术,还是最佳的药物治疗? [J].国际脑血管病杂志,2009, 17(5):393-399.

[21]Hoffmann A,Engelter S,Taschner C,et al.Carotid artery stenting versus carotid endarterectomy-a prospective randomized controlled single-centre trial with long-term follow-up (BACASS).Schweiz Arch Neurol Psychiatr.2008; 159:84-89.

[22]关敏,王晓白,刘小亚.颈动脉狭窄患者内膜剥脱术与支架植入术1年疗效Meta分析[J].中国介入影像与治疗学,2011,8(1):37-41.

[23]刘庆国，周宁,宋志斌,等.颈动脉支架与内膜切除术治疗颈动脉狭窄的疗效和安全性的META分析[J].中华老年医学杂志,2011, 30(5):369-373.