European Heart Journal Advance Access published online on September 18, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm362
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Safety of carotid artery stenting for symptomatic carotid artery disease: a meta-analysis
1 Division of Cardiovascular Medicine, University of Michigan Health System, 2A 394, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0311, USA
2 VA Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
3 Piedmont Hospital, Atlanta, GA, USA
Received 2 April 2007; revised 3 July 2007; accepted 26 July 2007.
* Corresponding author. Tel: +1 734 936 5544; fax: +1 734 764 4142. E-mail address: hgurm{at}med.umich.edu
Aims: Clinical trials comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA) for patients with symptomatic carotid artery disease have produced conflicting results. We performed a meta-analysis to systematically evaluate currently available data by comparing CAS with CEA in patients with symptomatic carotid artery disease.
Methods and results: We searched MEDLINE, Embase, ISI Web of Knowledge, Current Contents, International Pharmaceutical Abstracts databases, the Cochrane Central Register of Controlled Trials, and scientific meeting abstracts up to 31 October 2006 and then calculated summary risk ratios (RRs) for mortality, stroke, disabling stroke, and death using random- and fixed-effect models. Data from five trials with 2122 patients were pooled. There was no difference in risk of 30-day mortality (summary RR 0.57, 95% CI 0.22–1.47, P = 0.25), stroke (summary RR 1.64, 95% CI 0.67–4.00, P = 0.34), disabling stroke (summary RR 1.67, 95% CI 0.50–5.62, P = 0.50), death and stroke (summary RR 1.54, 95% CI 0.81–2.92, P = 0.19), or death and disabling stroke (summary RR 1.19, 95% CI 0.57–2.51, P = 0.64) among patients randomized to CAS, compared with CEA.
Conclusion: No significant differences could be identified between CAS and CEA in the treatment of patients with symptomatic carotid artery disease. Larger randomized controlled trials are warranted to compare the two strategies.
Key Words: Carotid artery disease • Carotid endarterectomy • Carotid stenting • Meta-analysis
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