Early Outcomes of Carotid Revascularization in Retrospective Case Series

Petroula Nana; George Kouvelos; Alexandros Brotis; Konstantinos Spanos; Efthimios Dardiotis; Miltiadis Matsagkas; Athanasios Giannoukas

doi:10.3390/jcm10050935

Early Outcomes of Carotid Revascularization in Retrospective Case Series

J Clin Med. 2021 Mar 1;10(5):935. doi: 10.3390/jcm10050935.

Authors

Petroula Nana¹, George Kouvelos¹, Alexandros Brotis², Konstantinos Spanos¹, Efthimios Dardiotis³, Miltiadis Matsagkas¹, Athanasios Giannoukas¹

Affiliations

¹ Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece.
² Department of Neurosurgery, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, 38221 Volos, Greece.
³ Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, 38221 Volos, Greece.

Abstract

Background: Most data in carotid stenosis treatment arise from randomized control trials (RCTs) and cohort studies. The aim of this meta-analysis was to compare 30-day outcomes in real-world practice from centers providing both modalities.

Methods: A data search of the English literature was conducted, using PubMed, EMBASE and CENTRAL databases, until December 2019, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) guidelines. Only studies reporting on 30-day outcomes from centers, where both techniques were performed, were eligible for this analysis.

Results: In total, 15 articles were included (16,043 patients). Of the patients, 68.1% were asymptomatic. Carotid artery stenting (CAS) did not differ from carotid endarterectomy (CEA) in terms of stroke (odds ratio (OR) 0.98; 0.77-1.25; I² = 0%), myocardial ischemic events (OR 1.03; 0.72-1.48; I² = 0%) and all events (OR 1.0; 0.82-1.21; I² = 0%). Pooled stroke incidence in asymptomatic patients was 1% (95% CI: 0-2%) for CEA and 1% for CAS (95% CI: 0-2%). Pooled stroke rate in symptomatic patients was 3% (95% CI: 1-4%) for CEA and 3% (95% CI: 1-4%) for CAS. The two techniques did not differ in either outcome both in asymptomatic and symptomatic patients.

Conclusion: Carotid revascularization, performed in centers providing both CAS and CEA, is safe and effective. Both techniques did not differ in terms of post-procedural neurological and cardiac events, both in asymptomatic and symptomatic patients. These findings reiterate the importance of a tailored therapeutic strategy and that "real-world" outcomes may only be valid from centers providing both treatments.

Keywords: carotid angioplasty; carotid endarterectomy; carotid revascularization; stent.

Publication types

Review