Your browser doesn't support javascript.
loading
Transcarotid Arterial Revascularization of Symptomatic Internal Carotid Artery Disease: A Systematic Review and Study-Level Meta-Analysis.
Ghannam, Malik; AlMajali, Mohammad; Khasiyev, Farid; Dibas, Mahmoud; Al Qudah, Abdullah; AlMajali, Fawaz; Ghazaleh, Dana; Shah, Asghar; Fayad, Fayez H; Joudi, Kareem; Zaidat, Bashar; Childs, Christopher A; Levy, Bennett R; Abouainain, Yasmeen; Özdemir-van Brunschot, Denise M D; Shu, Liqi; Goldstein, Eric D; Baig, Ammad A; Roeder, Hannah; Henninger, Nils; de Havenon, Adam; Levy, Elad I; Matouk, Charles; Derdeyn, Colin P; Leira, Enrique C; Chaturvedi, Seemant; Yaghi, Shadi.
Afiliação
  • Ghannam M; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
  • AlMajali M; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
  • Khasiyev F; Department of Neurology (F.K.), Saint Louis University, MO.
  • Dibas M; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
  • Al Qudah A; Department of Neurological Surgery, University of Pittsburgh Medical Center, PA (A.A.Q.).
  • AlMajali F; Department of General Surgery (F.A.), Saint Louis University, MO.
  • Ghazaleh D; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
  • Shah A; Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.).
  • Fayad FH; Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.).
  • Joudi K; Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.).
  • Zaidat B; Brown University, Providence, RI (A.S., F.H.F., K.J., B.Z.).
  • Childs CA; Hardin Library for the Health Sciences, The University of Iowa (C.A.C.).
  • Levy BR; George Washington School of Medicine and Health Sciences, DC (B.R.L.).
  • Abouainain Y; Faculty of Medicine, University of Jordan, Amman (Y.A.).
  • Özdemir-van Brunschot DMD; Faculty of Medicine, University of Witten-Herdecke, Germany (D.M.D.O.-v.B.).
  • Shu L; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (L.S., E.D.G., S.Y.).
  • Goldstein ED; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (L.S., E.D.G., S.Y.).
  • Baig AA; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.A.B., E.I.L.).
  • Roeder H; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY (A.A.B., E.I.L.).
  • Henninger N; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
  • de Havenon A; Department of Neurology, University of Massachusetts Chan Medical School, Worcester (N.H.).
  • Levy EI; Department of Neurology (A.d.H.), Yale University, New Haven, CT.
  • Matouk C; Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.A.B., E.I.L.).
  • Derdeyn CP; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY (A.A.B., E.I.L.).
  • Leira EC; Department of Neurosurgery (C.M.), Yale University, New Haven, CT.
  • Chaturvedi S; Department of Radiology (C.P.D.), University of Iowa College of Medicine.
  • Yaghi S; Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.).
Stroke ; 55(4): 921-930, 2024 Apr.
Article em En | MEDLINE | ID: mdl-38299350
ABSTRACT

BACKGROUND:

Transcarotid artery revascularization (TCAR) is an interventional therapy for symptomatic internal carotid artery disease. Currently, the utilization of TCAR is contentious due to limited evidence. In this study, we evaluate the safety and efficacy of TCAR in patients with symptomatic internal carotid artery disease compared with carotid endarterectomy (CEA) and carotid artery stenting (CAS).

METHODS:

A systematic review was conducted, spanning from January 2000 to February 2023, encompassing studies that used TCAR for the treatment of symptomatic internal carotid artery disease. The primary outcomes included a 30-day stroke or transient ischemic attack, myocardial infarction, and mortality. Secondary outcomes comprised cranial nerve injury and major bleeding. Pooled odds ratios (ORs) for each outcome were calculated to compare TCAR with CEA and CAS. Furthermore, subgroup analyses were performed based on age and degree of stenosis. In addition, a sensitivity analysis was conducted by excluding the vascular quality initiative registry population.

RESULTS:

A total of 7 studies involving 24 246 patients were analyzed. Within this patient cohort, 4771 individuals underwent TCAR, 12 350 underwent CEA, and 7125 patients underwent CAS. Compared with CAS, TCAR was associated with a similar rate of stroke or transient ischemic attack (OR, 0.77 [95% CI, 0.33-1.82]) and myocardial infarction (OR, 1.29 [95% CI, 0.83-2.01]) but lower mortality (OR, 0.42 [95% CI, 0.22-0.81]). Compared with CEA, TCAR was associated with a higher rate of stroke or transient ischemic attack (OR, 1.26 [95% CI, 1.03-1.54]) but similar rates of myocardial infarction (OR, 0.9 [95% CI, 0.64-1.38]) and mortality (OR, 1.35 [95% CI, 0.87-2.10]).

CONCLUSIONS:

Although CEA has traditionally been considered superior to stenting for symptomatic carotid stenosis, TCAR may have some advantages over CAS. Prospective randomized trials comparing the 3 modalities are needed.
Assuntos
Palavras-chave

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Stents / Endarterectomia das Carótidas / Estenose das Carótidas Tipo de estudo: Clinical_trials / Diagnostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Stroke Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Stents / Endarterectomia das Carótidas / Estenose das Carótidas Tipo de estudo: Clinical_trials / Diagnostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: Stroke Ano de publicação: 2024 Tipo de documento: Article