Stenting Versus Endarterectomy for Restenosis Following Prior Ipsilateral Carotid Endarterectomy: An Individual Patient Data Meta-analysis

• Published in: Annals of surgery Vol. 261; no. 3; pp. 598 - 604
• Main Authors: Fokkema, Margriet, Vrijenhoek, Joyce E P, Den Ruijter, Hester M, Groenwold, Rolf H H, Schermerhorn, Marc L, Bots, Michiel L, Pasterkamp, Gerard, Moll, Frans L, De Borst, Gert Jan
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-03-2015; Lippincott, Williams & Wilkins
• Subjects: Carotid Stenosis - mortality; Carotid Stenosis - surgery; Endarterectomy, Carotid; Human health and pathology; Humans; Life Sciences; Recurrence; Risk Assessment; Risk Factors; Stents; Stroke - mortality; Surgery; Time Factors
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000000799

OBJECTIVE:To study perioperative results and restenosis during follow-up of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for restenosis after prior ipsilateral CEA in an individual patient data (IPD) meta-analysis.
BACKGROUND:The optimal treatment strategy for patients with restenosis after CEA remains unknown.
METHODS:A comprehensive search of electronic databases (Medline, Embase) until July 1, 2013, was performed, supplemented by a review of references. Studies were considered for inclusion if they reported procedural outcome of CAS or CEA after prior ipsilateral CEA of a minimum of 5 patients. IPD were combined into 1 data set and an IPD meta-analysis was performed. The primary endpoint was perioperative stroke or death and the secondary endpoint was restenosis greater than 50% during follow-up, comparing CAS and CEA.
RESULTS:In total, 13 studies were included, contributing to 1132 unique patients treated by CAS (10 studies, n = 653) or CEA (7 studies; n = 479). Among CAS and CEA patients, 30% versus 40% were symptomatic, respectively (P < 0.01). After adjusting for potential confounders, the primary endpoint did not differ between CAS and CEA groups (2.3% vs 2.7%, adjusted odds ratio 0.8, 95% confidence interval (CI)0.4–1.8). Also, the risk of restenosis during a median follow-up of 13 months was similar for both groups (hazard ratio 1.4, 95% (CI)0.9–2.2). Cranial nerve injury (CNI) was 5.5% in the CEA group, while CAS was in 5% associated with other procedural related complications.
CONCLUSIONS:In patients with restenosis after CEA, CAS and CEA showed similar low rates of stroke, death, and restenosis at short-term follow-up. Still, the risk of CNI and other procedure-related complications should be taken into account.