Mark J. Alberts, MD
In patients with carotid artery disease, what is the relative efficacy and safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA)?
Included studies compared CAS with CEA in patients with carotid artery disease and reported outcomes of death, stroke, or myocardial infarction (MI).
MEDLINE, EMBASE/Excerpta Medica, Web of Science, and Cochrane Central Register of Controlled Trials were searched from 2008 to July 2010; trials published before 2008 were obtained from a previous version of this review. 13 randomized controlled trials (RCTs) met the selection criteria (n = 7484, mean age range 63 to 73 y, 80% symptomatic); most patients (57%) were included in 3 new RCTs published in or after 2008. Overall quality of the RCTs was high (GRADE framework). 8 trials had allocation concealment, and 4 trials had blinded outcome assessors. 5 trials were stopped early.
Meta-analysis showed that CAS increased risk for stroke and reduced risk for periprocedural MI compared with CEA; CAS and CEA did not differ for death (Table).
In patients with carotid artery disease, carotid artery stenting increases risk for stroke and decreases risk for myocardial infarction compared with carotid endarterectomy.
Carotid artery stenting (CAS) vs carotid endarterectomy (CEA) in patients with carotid artery disease*
*MI = myocardial infarction; other abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from control event rates and relative risks in article using a random-effects model.
Mark J. Alberts. Review: Stenting increases stroke but decreases periprocedural MI compared with endarterectomy in carotid artery disease. Ann Intern Med. 2011;155:JC2–10. doi: 10.7326/0003-4819-155-4-201108160-02010
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Published: Ann Intern Med. 2011;155(4):JC2-10.
Neurology, Prevention/Screening, Stroke.
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