Carotid Artery Endarterectomy (CEA) vs. Carotid Artery Stenting (CAS) for Restenosis after CEA: A Systematic Review and Meta-analysis.

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Carotid Artery Endarterectomy (CEA) vs. Carotid Artery Stenting (CAS) for Restenosis after CEA: A Systematic Review and Meta-analysis.

World Neurosurg. 2018 Apr 16;:

Authors: Texakalidis P, Giannopoulos S, Jonnalagadda AK, Kokkinidis DG, Machinis T, Reavey-Cantwell J, Armstrong EJ, Jabbour P

Abstract
BACKGROUND: Carotid artery restenosis may occur following ipsilateral carotid endarterectomy (CEA). It remains unclear whether carotid artery stenting (CAS) or a repeat CEA (redoCEA) is the best treatment strategy for carotid artery restenosis.
OBJECTIVE: We sought to find whether CAS or redoCEA is the optimal therapy for post-endarterectomy carotid restenosis.
METHODS: This study was performed according to the PRISMA and MOOSE guidelines. Eligible studies were identified through a search of PubMed, Scopus and Cochrane until July 20, 2017. A meta-analysis was conducted with the use of random effects modeling. I-square was used to assess for heterogeneity.
RESULTS: Thirteen studies involving 4,163 patients were included. The risk for any type of cranial nerve (CN) injury was higher in the redoCEA group (OR: 13.61; 95% CI: 5.43 - 34.16; I2 =3.3%). Periprocedural/short-term (within 30 days) stroke, transient ischemic attack (TIA), myocardial infarction (MI), temporary CN injury and death rates were similar between the two revascularization approaches. During a median follow-up of 28 months CAS was associated with significantly lower risk for long-term recurrent carotid artery restenosis, when defined as stenosis >60% (OR: 2.16; 95% CI: 1.13 - 4.12; I2 =0%) or as stenosis >70% (OR: 2.31; 95% CI: 1.13 - 4.72; I2 =0%). No difference was identified in long-term target lesion revascularization rates between redoCEA and CAS.
CONCLUSIONS: Patients with carotid restenosis after CEA can safely undergo both CAS and CEA with similar risks of periprocedural stroke, TIA, MI and death. However, patients treated with CAS have a lower risk for a new restenosis and periprocedural CN injury.

PMID: 29673823 [PubMed - as supplied by publisher]

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