Carotid Endarterectomy Plus Medical Therapy or Medical Therapy Alone for Carotid Artery Stenosis in Symptomatic or Asymptomatic Patients: A Meta-Analysis
Journal of Cardiothoracic and Vascular Anesthesia, 04/13/2012
Evidence Based Medicine
Guay J et al. – Carotid endarterectomy (CEA) is helpful for recently symptomatic patients with carotid artery stenosis ≥50% (NASCET technique) but adds no benefit in terms of stroke/death for asymptomatic patients.Methods
- For asymptomatic patients, 6 RCTs comprising 5,733 patients (CEA=2,853 and MT=2,880) were included.
- CEA did not affect the stroke/death risk for asymptomatic patients (risk ratio [RR]=0.93; 95% confidence interval [CI], 0.84 to 1.02; I2=0%; p=0.14).
- For symptomatic patients, 2 RCTs were included.
- They had 5,627 patients (CEA=3,069 and MT=2,558) of whom 2,295 patients (CEA=1,213; MT=1,082) had severe stenosis (North American Symptomatic Carotid Endarterectomy Trial [NASCET] technique ≥50% and European Carotid Surgery Trial technique ≥70%).
- CEA decreased the stroke/death risk only for patients with severe stenosis (RR=0.69; 95% CI, 0.59-0.81; p<0.001 [random effects model]; I2=0% on the odds ratio and 17% on the RR [benefit or harm side]; number needed to treat=11 [95% CI, 8-17]).