Carotid Revascularization in the Elderly: a Systematic Review and Meta-analysis.

Carotid Revascularization in the Elderly: a Systematic Review and Meta-analysis.

World Neurosurg. 2019 Feb 21;:

Authors: Texakalidis P, Chaitidis N, Giannopoulos S, Giannopoulos S, Machinis T, Jabbour P, Rivet D, Reavey-Cantwell J, Rangel-Castilla L

Abstract
BACKGROUND: Results from studies comparing carotid artery endarterectomy (CEA) versus carotid artery stenting (CAS) in the elderly population are variable in the literature.
OBJECTIVE: To investigate whether CEA or CAS is associated with a better safety profile in the elderly (age>80 years old) for treatment of symptomatic and asymptomatic stenosis.
METHODS: A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA guidelines. Subgroup analyses were performed as needed.
RESULTS: Nine studies comprising 5,955 patients were included in this meta-analysis. No differences were identified in terms of 30-day stroke [CEA: 5.8% (N=257/4,415), CAS: 10.5% (N=81/767), OR: 0.57; 95% CI: 0.30-1.08; I2=26.1%), myocardial infarction (MI) [CEA: 1.1% (N=4/357), CAS: 0.5% (N=2/355), OR: 1.67; 95% CI: 0.37-7.46; I2=0%], transient ischemic attack (TIA) [CEA: 0% (N=0/98), CAS: 4.2% (N=7/166), OR: 0.28; 95% CI: 0.03-2.52; I2=0%], death [CEA: 1.5% (N=8/523), CAS: 0.9% (N=4/431), OR: 1.41; 95% CI: 0.43-4.58; I2=0%] and cranial nerve injury [CEA: 5.8% (N=3/51), CAS: 0% (N=0/51), OR: 4.74; 95% CI: 0.5-44.98; I2=0%]. A subgroup comparing CEA vs transfemoral protected CAS showed that patients in the CEA group had a statistically significant lower risk of 30-day stroke (OR: 0.31; 95% CI: 0.17-0.57; I2=30.8%).
CONCLUSIONS: This study shows that CEA is associated with a statistically significant lower risk of 30-day stroke in the elderly population as compared to transfemoral CAS with distal or proximal protection. No differences were noted in the rates of peri-procedural TIA, MI, death and cranial nerve injury between CEA and CAS in the original pooled analysis.

PMID: 30797928 [PubMed - as supplied by publisher]

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