Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials

Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao HuangDepartment of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of ChinaObjective: To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery st...

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Autores principales:	Ouyang YA, Jiang Y, Yu M, Zhang Y, Huang H
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	symptomatic carotid-artery stenosis carotid artery stenting carotid artery endarterectomy CAS CEA Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/dd4d7e0cb81c433685069bfe88b6f747
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spelling	oai:doaj.org-article:dd4d7e0cb81c433685069bfe88b6f7472021-12-02T07:27:33ZEfficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials1178-1998https://doaj.org/article/dd4d7e0cb81c433685069bfe88b6f7472015-10-01T00:00:00Zhttps://www.dovepress.com/efficacy-and-safety-of-stenting-for-elderly-patients-with-severe-and-s-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao HuangDepartment of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of ChinaObjective: To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) for elderly patients with severe and symptomatic carotid artery stenosis.Methods: PubMed, EMBASE, Cochrane Library, Clinical Trials Register Centers, and Google Scholar were comprehensively searched. After identifying relevant randomized controlled trials, methodological quality was assessed by using Cochrane tools of bias assessment. Meta-analysis was performed by RevMan software, and subgroup analyses according to different follow-up periods were also conducted.Results: Sixteen articles of nine randomized controlled trials containing 6,984 patients were included. Compared with CEA, CAS was associated with high risks of stroke during periprocedural 30 days (risk ratio [RR]=1.47, 95% confidence interval [CI]: 1.15–1.88), 48 months (RR=1.37, 95% CI: 1.11–1.70), and >48 months (RR=1.76, 95% CI: 1.34–2.31). There was no significant difference in the aspects of death, disabling stroke, or death at any time between the groups. For other periprocedural complications, CAS decreased the risk of myocardial infarction (RR=0.44, 95% CI: 0.26–0.75), cranial nerve palsy (RR=0.09, 95% CI: 0.04–0.22) and hematoma (RR=0.31, 95% CI: 0.14–0.68) compared with CEA, while it increased the risk of bradycardia or hypotension (RR=8.45, 95% CI 2.91–24.58).Conclusion: Compared with CEA, CAS reduced hematoma, periprocedural myocardial infarction, and cranial nerve palsy, while it was associated with higher risks of both short-term and long-term nondisabling stroke. And they seemed to be equivalent in other outcome measures. As regards to its minimal invasion, it should be applied only in specific patients.Keywords: symptomatic carotid artery stenosis, carotid artery stenting, carotid artery endarterectomyOuyang YAJiang YYu MZhang YHuang HDove Medical Pressarticlesymptomatic carotid-artery stenosiscarotid artery stentingcarotid artery endarterectomyCASCEAGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 1733-1742 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	symptomatic carotid-artery stenosis carotid artery stenting carotid artery endarterectomy CAS CEA Geriatrics RC952-954.6
spellingShingle	symptomatic carotid-artery stenosis carotid artery stenting carotid artery endarterectomy CAS CEA Geriatrics RC952-954.6 Ouyang YA Jiang Y Yu M Zhang Y Huang H Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
description	Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao HuangDepartment of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of ChinaObjective: To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) for elderly patients with severe and symptomatic carotid artery stenosis.Methods: PubMed, EMBASE, Cochrane Library, Clinical Trials Register Centers, and Google Scholar were comprehensively searched. After identifying relevant randomized controlled trials, methodological quality was assessed by using Cochrane tools of bias assessment. Meta-analysis was performed by RevMan software, and subgroup analyses according to different follow-up periods were also conducted.Results: Sixteen articles of nine randomized controlled trials containing 6,984 patients were included. Compared with CEA, CAS was associated with high risks of stroke during periprocedural 30 days (risk ratio [RR]=1.47, 95% confidence interval [CI]: 1.15–1.88), 48 months (RR=1.37, 95% CI: 1.11–1.70), and >48 months (RR=1.76, 95% CI: 1.34–2.31). There was no significant difference in the aspects of death, disabling stroke, or death at any time between the groups. For other periprocedural complications, CAS decreased the risk of myocardial infarction (RR=0.44, 95% CI: 0.26–0.75), cranial nerve palsy (RR=0.09, 95% CI: 0.04–0.22) and hematoma (RR=0.31, 95% CI: 0.14–0.68) compared with CEA, while it increased the risk of bradycardia or hypotension (RR=8.45, 95% CI 2.91–24.58).Conclusion: Compared with CEA, CAS reduced hematoma, periprocedural myocardial infarction, and cranial nerve palsy, while it was associated with higher risks of both short-term and long-term nondisabling stroke. And they seemed to be equivalent in other outcome measures. As regards to its minimal invasion, it should be applied only in specific patients.Keywords: symptomatic carotid artery stenosis, carotid artery stenting, carotid artery endarterectomy
format	article
author	Ouyang YA Jiang Y Yu M Zhang Y Huang H
author_facet	Ouyang YA Jiang Y Yu M Zhang Y Huang H
author_sort	Ouyang YA
title	Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
title_short	Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
title_full	Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
title_fullStr	Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
title_full_unstemmed	Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
title_sort	efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/dd4d7e0cb81c433685069bfe88b6f747
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Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials

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