Systematic and Comprehensive Comparison of Incidence of Restenosis between Carotid Endarterectomy and Carotid Artery Stenting in the Patients with Atherosclerotic Carotid Stenosis.

Systematic and Comprehensive Comparison of Incidence of Restenosis between Carotid Endarterectomy and Carotid Artery Stenting in the Patients with Atherosclerotic Carotid Stenosis.

World Neurosurg. 2019 Jan 30;:

Authors: Xin WQ, Li MQ, Li K, Li QF, Zhao Y, Wang WH, Gao YK, Wang HY

Abstract
OBJECTIVE: The purpose of this study was to conduct a meta-analysis to systematically compare the incidence rates of in-stent restenosis after CAS and restenosis after CEA for patients with atherosclerotic carotid stenosis.
METHOD: This study retrieved potential academic articles comparing restenosis between Carotid Endarterectomy (CEA) and Carotid Artery Stenting (CAS) from the MEDLINE database, the PubMed database the EMBASE database, and the Cochrane Library from the period between the date of the first CEA, performed in January 1951, and July 20, 2018. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study.
RESULT: A total of 27 articles (15 RCTs, 12 non-RCTs) including 20,479 participants with atherosclerotic carotid stenosis were included in our meta-analysis. There was a significant difference in the cumulative incidence of restenosis >70% between endarterectomy and stenting [RD=-0.033, 95% CI (-0.054 - -0.013) P=0.002]. In terms of restenosis >70% outcomes, although CEA was relevant with a lower rate of restenosis than CAS within 0.5 years [OR=0.495, 95% CI (0.285-0.861) P=0.013] and 1 year [OR=0.626, 95% CI (0.483-0.811), P<0.001], no statistically significant differences were found at 1.5 years (P=0.210), 2 years (P=0.123), 4 years (P=0.124), 5 years (P=0.327) and 10 years (P=0.839). Similarly, in terms of restenosis >50% outcomes, a significant difference was shown in the rates of restenosis between the endarterectomy and stenting groups within 1 year [OR =0.317, 95% CI (0.228-0.441), P<0.001], but not at 1.5 years (P=0.301), 2 years (P=0.686) or 5 years (P=0.920). Simultaneously, no nominally significant effects were demonstrated with respect to the cumulative incidence of occlusion (P=0.195) and the cumulative incidence of restenosis for symptomatic patients (P=0.170) between endarterectomy and stenting.
CONCLUSIONS: Although CAS was preferred over restenosis regardless of restenosis >50% or 70% after revascularization within 1 year, no significant difference was observed with extension of the follow-up period to more than 1 year. Simultaneously, CAS was not associated with a higher cumulative incidence of occlusion and the cumulative incidence of restenosis for symptomatic patients.

PMID: 30710719 [PubMed - as supplied by publisher]

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