Universität zu Köln

Luebke, Thomas and Brunkwall, Jan (2016). Carotid artery stenting versus carotid endarterectomy: updated meta-analysis, metaregression and trial sequential analysis of short-term and intermediate-to long-term outcomes of randomized trials. J. Cardiovasc. Surg., 57 (4). S. 519 - 540. TURIN: EDIZIONI MINERVA MEDICA. ISSN 1827-191X

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Abstract

INTRODUCTION: To compare carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in the treatment of carotid stenosis, including two recently published, prospective, randomized trials of these therapies. EVIDENCE ACQUISITION: A multiple electronic health database search on all randomized trials describing CAS compared with CEA in patients with symptomatic or asymptomatic carotid artery stenosis was performed. Primary outcomes were death, stroke, and myocardial infarction. EVIDENCE SYNTHESIS: Carotid artery stenting as compared with CEA was associated with a 61% increase in the risk of periprocedural death or stroke (Peto OR, 1.609; 95% confidence interval [CI]: 1.193-2.170; P=0.002). The trial sequential monitoring boundary was crossed by the cumulative Z-curve, suggesting firm evidence for at least a 20% relative risk increase of periprocedural death or stroke and any stroke compared with CEA. Carotid artery stenting as compared with CEA was associated with a 42% increase in the risk for the composite of periprocedural stroke or death plus ipsilateral stroke thereafter (Peto OR, 1.417; 95% CI: 1.074-1.870; P=0.0014). CONCLUSIONS: In this largest and most comprehensive meta-analysis to date using outcomes that are standard in contemporary studies, CAS was associated with an increased risk of both periprocedural and intermediate- to long-term outcomes.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Luebke, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunkwall, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-267386
Journal or Publication Title:	J. Cardiovasc. Surg.
Volume:	57
Number:	4
Page Range:	S. 519 - 540
Date:	2016
Publisher:	EDIZIONI MINERVA MEDICA
Place of Publication:	TURIN
ISSN:	1827-191X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SYSTEMATIC REVIEWS; INFORMATION SIZE; FOLLOW-UP; STENOSIS; ANGIOPLASTY; RISK; BIAS Multiple languages Cardiac & Cardiovascular Systems; Surgery; Peripheral Vascular Disease Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26738