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Carotid Artery Endarterectomy versus Carotid Artery Stenting for Restenosis After Carotid Artery Endarterectomy: A Systematic Review and Meta-Analysis. [Review]

MedStar author(s):

Citation: World Neurosurgery. 115:421-429.e1, 2018 Jul.PMID: 29673823Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewYear: 2018 ISSN:

1878-8750

Name of journal: World neurosurgeryAbstract: CONCLUSIONS: Patients with carotid restenosis after CEA can safely undergo both CAS and CEA with similar risks of periprocedural stroke, transient ischemic attack, myocardial infarction, and death. However, patients treated with CAS have a lower risk for a new restenosis and periprocedural cranial nerve injury.Copyright (c) 2018 Elsevier Inc. All rights reserved.METHODS: Eligible studies for meta-analysis were identified through a search of PubMed, Scopus, and Cochrane up to July 20, 2017. A meta-analysis was conducted with the use of random effects modeling. I2 was used to assess for heterogeneity.OBJECTIVE: Carotid artery restenosis may occur after ipsilateral carotid endarterectomy (CEA). The aim of this study was to determine whether carotid artery stenting (CAS) or redo CEA is the optimal treatment for postendarterectomy carotid restenosis.RESULTS: Thirteen studies comprising 4163 patients were included. Risk for any type of cranial nerve injury was higher in the redo CEA group (odds ratio = 13.61; 95% confidence interval, 5.43-34.16; I2 = 3.3%). Periprocedural and/or short-term (within 30 days) stroke, transient ischemic attack, myocardial infarction, temporary cranial nerve injury, and death rates were similar between the 2 revascularization approaches. During median follow-up of 28 months, CAS was associated with significantly lower risk for long-term recurrent carotid artery restenosis when defined as stenosis >60% (odds ratio = 2.16; 95% confidence interval, 1.13-4.12; I2 = 0%) or >70% (odds ratio = 2.31; 95% confidence interval, 1.13-4.72; I2 = 0%). No difference was identified in long-term target lesion revascularization rates between redo CEA and CAS.All authors: Armstrong EJ, Giannopoulos S, Jabbour P, Jonnalagadda AK, Kokkinidis DG, Machinis T, Reavey-Cantwell J, Texakalidis PFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.1016/j.wneu.2018.02.196

Date added to catalog: 2018-06-19

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Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	29673823	Available		29673823

CONCLUSIONS: Patients with carotid restenosis after CEA can safely undergo both CAS and CEA with similar risks of periprocedural stroke, transient ischemic attack, myocardial infarction, and death. However, patients treated with CAS have a lower risk for a new restenosis and periprocedural cranial nerve injury.

METHODS: Eligible studies for meta-analysis were identified through a search of PubMed, Scopus, and Cochrane up to July 20, 2017. A meta-analysis was conducted with the use of random effects modeling. I2 was used to assess for heterogeneity.

OBJECTIVE: Carotid artery restenosis may occur after ipsilateral carotid endarterectomy (CEA). The aim of this study was to determine whether carotid artery stenting (CAS) or redo CEA is the optimal treatment for postendarterectomy carotid restenosis.

RESULTS: Thirteen studies comprising 4163 patients were included. Risk for any type of cranial nerve injury was higher in the redo CEA group (odds ratio = 13.61; 95% confidence interval, 5.43-34.16; I2 = 3.3%). Periprocedural and/or short-term (within 30 days) stroke, transient ischemic attack, myocardial infarction, temporary cranial nerve injury, and death rates were similar between the 2 revascularization approaches. During median follow-up of 28 months, CAS was associated with significantly lower risk for long-term recurrent carotid artery restenosis when defined as stenosis >60% (odds ratio = 2.16; 95% confidence interval, 1.13-4.12; I2 = 0%) or >70% (odds ratio = 2.31; 95% confidence interval, 1.13-4.72; I2 = 0%). No difference was identified in long-term target lesion revascularization rates between redo CEA and CAS.

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