Περίληψη:
Background: To compare eversion (ECEA) and conventional (CCEA) carotid
endarterectomy from randomised and non-randomised studies.
Methods: Pooled odds ratios (ORs) with 95% confidence intervals
(95%CIs) and numbers needed to treat (NNTs) were appropriately
calculated. A sub-analysis was performed on studies directly comparing
ECEA vs. patch CEA (PCEA). Meta-regression analysis was performed to
examine the effect of potentially meaningful patient-related,
procedure-related and definition-related modifiers. Power calculations
were also conducted.
Results: A total of 21 studies were deemed eligible (8530 ECEA and 7721
CCEA procedures), seven of which were randomised and 14 non-randomised.
ECEA was associated with significant reduction in perioperative stroke
(OR = 0.46, 95%CI: 0.35-0.62, NNT = 68, 95%CI: 56-96), death (OR =
0.49, 95%CI: 0.34-0.69, NNT = 100, 95%CI: 85 -185) and stroke-related
death (OR = 0.40, 95%CI: 0.23-0.67, NNT = 147, 95%CI: 115 -270); the
results were replicated at the sub-analysis on PCEA. Concerning
long-term outcomes, ECEA presented with a significant reduction in late
carotid artery occlusion (OR = 0.48, 95%CI: 0.25-0.90, NNT = 143,
95%CI: 100-769) and late mortality (OR = 0.76, 95%CI: 0.61-0.94, NNT =
40, 95%CI: 25-167); the sub-analysis on PCEA replicated only the
finding on late mortality. Meta-regression analysis did not point to
significant effects mediated by the examined modifiers. Power
calculations suggested adequate statistical power.
Conclusions: ECEA compared to CCEA may be associated with a lower
incidence in both short-term and long-term outcomes, which does not seem
to be hampered by potentially meaningful modifiers. (C) 2011 European
Society for Vascular Surgery. Published by Elsevier Ltd. All rights
reserved.
Συγγραφείς:
Antonopoulos, C. N.
Kakisis, J. D.
Sergentanis, T. N. and
Liapis, C. D.
