Long term durability and outcomes of carotid stenting and carotid endarterectomy

Jin-Man Jung, Jeong Yoon Choi, Hyun Jung Kim, Sang-Il Suh, Woo Keun Seo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA). Methods Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration. Results 22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points. Conclusions Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.

Original languageEnglish
Pages (from-to)750-755
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number8
DOIs
Publication statusPublished - 2017 Aug 1

Fingerprint

Carotid Endarterectomy
Angioplasty
Stroke
Pathologic Constriction
Myocardial Infarction
Carotid Stenosis
Meta-Analysis
Randomized Controlled Trials
Databases

Keywords

  • Angioplasty
  • Atherosclerosis
  • Intervention

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Long term durability and outcomes of carotid stenting and carotid endarterectomy. / Jung, Jin-Man; Choi, Jeong Yoon; Kim, Hyun Jung; Suh, Sang-Il; Seo, Woo Keun.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 8, 01.08.2017, p. 750-755.

Research output: Contribution to journalArticle

Jung, Jin-Man ; Choi, Jeong Yoon ; Kim, Hyun Jung ; Suh, Sang-Il ; Seo, Woo Keun. / Long term durability and outcomes of carotid stenting and carotid endarterectomy. In: Journal of NeuroInterventional Surgery. 2017 ; Vol. 9, No. 8. pp. 750-755.
@article{04396ab76d8442f8967e2bc2dd7ac18a,
title = "Long term durability and outcomes of carotid stenting and carotid endarterectomy",
abstract = "Purpose To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA). Methods Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration. Results 22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points. Conclusions Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.",
keywords = "Angioplasty, Atherosclerosis, Intervention",
author = "Jin-Man Jung and Choi, {Jeong Yoon} and Kim, {Hyun Jung} and Sang-Il Suh and Seo, {Woo Keun}",
year = "2017",
month = "8",
day = "1",
doi = "10.1136/neurintsurg-2016-012293",
language = "English",
volume = "9",
pages = "750--755",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "8",

}

TY - JOUR

T1 - Long term durability and outcomes of carotid stenting and carotid endarterectomy

AU - Jung, Jin-Man

AU - Choi, Jeong Yoon

AU - Kim, Hyun Jung

AU - Suh, Sang-Il

AU - Seo, Woo Keun

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Purpose To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA). Methods Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration. Results 22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points. Conclusions Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.

AB - Purpose To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA). Methods Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration. Results 22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points. Conclusions Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.

KW - Angioplasty

KW - Atherosclerosis

KW - Intervention

UR - http://www.scopus.com/inward/record.url?scp=85024479014&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85024479014&partnerID=8YFLogxK

U2 - 10.1136/neurintsurg-2016-012293

DO - 10.1136/neurintsurg-2016-012293

M3 - Article

C2 - 27402858

AN - SCOPUS:85024479014

VL - 9

SP - 750

EP - 755

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 8

ER -