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首页> 外文期刊>International angiology: A journal of the International Union of Angiology >Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials.
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Carotid endarterectomy versus carotid angioplasty with or without stenting for treatment of carotid artery stenosis: an updated meta-analysis of randomized controlled trials.

机译：颈动脉内膜切除术与颈动脉血管成形术联合或不联合支架治疗颈动脉狭窄：随机对照试验的最新荟萃分析。

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Carotid angioplasty with or without stent placement (CAS) has been proposed as an alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis. We performed a systematic review and meta-analysis of randomized controlled trials to compare the safety and efficacy of endovascular techniques with surgery for carotid stenosis. We searched MEDLINE, PubMed and Cochrane databases to identify randomized controlled trials comparing CAS with CEA. Both random and fixed effects models were used to calculate the pooled odds ratios (OR) and their confidence intervals, with values lower than one indicating a benefit from the endovascular approach. Continuity correction was used for studies with zero events in one arm. We identified 11 trials randomizing a total of 3 258 patients; 1 623 to CEA and 1 635 to CAS. By random effects model, there was no significant difference between the treatments for any stroke (OR, 1.28; 95% CI, 0.82-2.02), or death or any stroke at 30-day (OR, 1.30; 95% CI, 0.92-1.84) and death or any stroke at 6 months (OR, 1.34; 95% CI, 0.86-2.09) or 1 year (OR, 1.41; 95% CI, 0.24-8.27). However there was a significantly higher risk of 30-day death or any stroke (OR, 1.33; 95% CI, 1.01-1.75) after CAS by fixed effects model. Endovascular treatment significantly reduced the risk of 30-day cranial nerve injury (OR, 0.13; 95% CI, 0.04-0.44). In conclusion treating carotid artery stenosis with CAS offers lower rates of cranial nerve injury compared with CEA. CAS could not be proved to be as safe as CEA in treating carotid artery stenosis. The results of ongoing randomized trials comparing CAS with CEA are easily awaited because they may provide sufficient evidence for a change in clinical practice.
机译：已经提出了有或没有支架置入术（CAS）的颈动脉血管成形术，作为颈动脉内膜切除术（CEA）的替代方法，用于治疗颈动脉狭窄。我们对随机对照试验进行了系统的回顾和荟萃分析，以比较血管内技术与颈动脉狭窄手术的安全性和有效性。我们搜索了MEDLINE，PubMed和Cochrane数据库，以确定将CAS与CEA进行比较的随机对照试验。随机效应模型和固定效应模型均用于计算合并的优势比（OR）及其置信区间，其值小于1则表明可从血管内方法中获益。连续性校正用于单臂零事件的研究。我们确定了11项试验，随机分配了3 258例患者。 CEA为1 623，CAS为1 635。通过随机效应模型，对于任何中风（OR，1.28; 95％CI，0.82-2.02），死亡或在30天时任何中风（OR，1.30; 95％CI，0.92-），治疗之间均无显着差异。 1.84）以及6个月（OR，1.34; 95％CI，0.86-2.09）或1年（OR，1.41; 95％CI，0.24-8.27）时的死亡或中风。然而，采用固定效应模型后，CAS发生30天死亡或中风的风险显着更高（OR，1.33; 95％CI，1.01-1.75）。血管内治疗显着降低了30天颅神经损伤的风险（OR，0.13; 95％CI，0.04-0.44）。总之，与CEA相比，CAS治疗颈动脉狭窄的颅神经损伤率更低。不能证明CAS在治疗颈动脉狭窄方面与CEA一样安全。比较CAS与CEA的正在进行的随机试验的结果很容易等待，因为它们可以为临床实践的改变提供足够的证据。

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