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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

Authors Ouyang YA, Jiang Y, Yu M, Zhang Y, Huang H

Received 3 July 2015

Accepted for publication 17 August 2015

Published 28 October 2015 Volume 2015:10 Pages 1733—1742

DOI https://doi.org/10.2147/CIA.S91721

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Supriya Swarnkar

Peer reviewer comments 4

Editor who approved publication: Professor Zhi-Ying Wu

Yi-An Ouyang, Yugang Jiang, Mengqiang Yu, Yunze Zhang, Hao Huang

Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People’s Republic of China

Objective: 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

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