In adults with asymptomatic carotid stenosis, is stenting as effective and safe as endarterectomy?
In this systematic review, while composite outcomes are similar in adults with asymptomatic carotid stenosis who undergo CAS or CEA, the short-term stroke risk is higher in those undergoing CAS. These data reinforce the need for local complication data — if you practice in an area where the complication rate of these procedures is greater than the stroke risk, either don’t refer at all or send your patient elsewhere.
Plan de l'etude:
Meta-analysis (randomized controlled trials)
Self-funded or unfunded
These authors searched several databases and registries to identify randomized trials that compared carotid artery stenting (CAS) with carotid endarterectomy (CEA) in adults with asymptomatic carotid stenosis. They excluded studies presented only in abstract form and published in any language other than English. Ultimately, they included 11 publications from 7 trials with 7117 asymptomatic patients (CAS: n = 3919; CEA: n = 3198). Overall, the studies were at low risk of bias, although the authors report issues with allocation and selective outcome reporting. During the first month after the procedures, the authors report no difference in the composite outcome of stroke, death, and myocardial infarction (3.5% vs 3.2% for CAS and CEA, respectively), although strokes occurred more frequently in the CAS-treated patients (3.0% vs 1.9%; number needed to treat to harm [NNTH] = 94; 95% CI 56 - 309) as did nondisabling strokes (2.5% vs 1.4%; NNTH 95; 58 - 267). Although the authors report no differences in the long-term composite outcomes between the 2 interventions, they don’t define “long-term” and don’t provide individual outcome data. The authors found no heterogeneity among the data.
Please note: This POEM was originally written in November 2022, but our team identified several errors in the original paper. The authors of the original paper have issued corrections, none of which substantively change the data and conclusions in this POEM.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI