Τίτλος:
Carotid Revascularization in Older Adults: A Systematic Review and Meta-Analysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Results from studies comparing carotid artery endarterectomy (CEA) with carotid artery stenting (CAS) in the elderly population are variable in the literature. The objective of this study was to investigate whether CEA or CAS is associated with a better safety profile in older adults (>80 years of age) for treatment of symptomatic and asymptomatic stenosis. Methods: A random-effects meta-analysis was performed, and the I2 statistic was used to assess heterogeneity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses were performed as needed. Results: Nine studies comprising 5955 patients were included in this meta-analysis. No differences were identified in terms of 30-day stroke (CEA: 5.8% [n = 257/4415]; CAS: 10.5% [n = 81/767]; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.30–1.08; I2 = 26.1%), myocardial infarction (MI) (CEA: 1.1% [n = 4/357]; CAS: 0.5% [n = 2/355]; OR, 1.67; 95% CI, 0.37–7.46; I2 = 0%), transient ischemic attack (TIA) (CEA: 0% [n = 0/98]; CAS: 4.2% [n = 7/166]; OR, 0.28; 95% CI, 0.03–2.52; I2 = 0%), death (CEA: 1.5% [n = 8/523]; CAS: 0.9% [n = 4/431]; OR, 1.41; 95% CI, 0.43–4.58; I2 = 0%), and cranial nerve injury (CEA: 5.8% [n = 3/51]; CAS: 0% [n = 0/51]; OR, 4.74; 95% CI, 0.5–44.98; I2 =0%). A subgroup comparing CEA with transfemoral protected CAS showed that patients in the CEA group had a statistically significant lower risk of 30-day stroke (OR, 0.31; 95% CI, 0.17–0.57; I2 = 30.8%). Conclusions: This study shows that CEA is associated with a statistically significant lower risk of 30-day stroke in the elderly population compared with transfemoral CAS with distal or proximal protection. No differences were noted in the rates of periprocedural TIA, MI, death, and cranial nerve injury between CEA and CAS in the original pooled analysis. © 2019 Elsevier Inc.
Συγγραφείς:
Texakalidis, P.
Chaitidis, N.
Giannopoulos, S.
Giannopoulos, S.
Machinis, T.
Jabbour, P.
Rivet, D.
Reavey-Cantwell, J.
Rangel-Castilla, L.
Περιοδικό:
World Neurosurgery
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Λέξεις-κλειδιά:
age; aged; carotid artery obstruction; carotid endarterectomy; cerebral revascularization; cerebrovascular accident; cranial nerve injury; female; human; male; meta analysis; peroperative complication; postoperative complication; procedures; stent; survival analysis; treatment outcome; very elderly, Age Factors; Aged; Aged, 80 and over; Carotid Stenosis; Cerebral Revascularization; Cranial Nerve Injuries; Endarterectomy, Carotid; Female; Humans; Intraoperative Complications; Male; Postoperative Complications; Stents; Stroke; Survival Analysis; Treatment Outcome
DOI:
10.1016/j.wneu.2019.02.030
