Editor's Choice - Timing of Carotid Intervention in Symptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Coelho, A (Author) FMUP; Peixoto, J (Author) Other; Mansilha A. (Author) FMUP; Naylor, AR (Author) Other; de Borst, GJ (Author) Other

Journal

Title: European Journal of Vascular and Endovascular Surgery

Vol. 63

Pages: 3-23

ISSN: 1078-5884

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 8 Citations

Scopus - 7 Citations

Other information

Authenticus ID: P-00V-ZR8

DOI: 10.1016/j.ejvs.2021.08.021

Abstract (EN): Objective: This review aimed to analyse the timing of carotid endarterectomy (CEA) and carotid artery stenting (CAS) after the index event as well as 30 day outcomes at varying time periods within 14 days of symptom onset. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analysis statement, comprising an online search of the Medline and Cochrane databases. Methodical quality assessment of the included studies was performed. Endpoints included procedural stroke and/or death stratified by delay from the index event and surgical technique (CEA/CAS). Results: Seventy-one studies with 232 952 symptomatic patients were included. Overall, 34 retrospective analyses of prospective databases, nine prospective, three RCT, three case control, and 22 retrospective studies were included. Compared with CEA, CAS was associated with higher 30 day stroke (OR 0.70; 95% CI 0.58 - 0.85) and mortality rates (OR 0.41; 95% CI 0.31 - 0.53) when performed <= 2 days of symptom onset. Patients undergoing CEA/CAS were analysed in different time frames (<= 2 vs. 3 - 14 and <= 7 vs. 8 - 14 days). Expedited CEA (vs. 3 - 14 days) presented a sampled 30 day stroke rate of 1.4%; 95% CI 0.9 - 1.8 vs. 1.8%; 95% CI 1.8 - 2.0, with no statistically significant difference. Expedited CAS (vs. 3 - 14 days) was associated with no difference in stroke rate but statistically significantly higher mortality rate (OR 2.76; 95% CI 1.39 - 5.50). Conclusion: At present, CEA is safer than transfemoral CAS within 2/7 days of symptom onset. Also, considering absolute rates, expedited CEA complies with the accepted thresholds in international guidelines. The ideal timing for performing CAS (when indicated against CEA) is not yet defined. Additional granular data and standard reporting of timing of intervention will facilitate future monitoring.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 21