A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy

Abstract

Routine carotid patch angioplasty was associated with promising reductions in the risks of ipsilateral stroke and death, but the results should be interpreted cautiously because of the small number of outcome events, significant losses to follow-up, and poor trial methodology. Ideally, a large definitive trial should be performed. There is insufficient evidence to support the preferential use of one particular type of patch versus another.

Basics of Systematic Reviews and Meta-Analyses for the Nephrologist

“…This will minimize bias and increase the chance that the conclusions of the review are valid [26,37,42]. The primary step is to formulate a focused and clearly defined research question [16,42,43]. It is always better to frame a narrow and specific question.…”

“…A broad question such as ‘what is the most appropriate prophylactic measure for the prevention of haemodialysis catheter infections’ would be better framed as ‘what is the role of antibiotics or the role of catheter lock solutions in the prevention of access-related infections in haemodialysis patients’. It is recommended to describe the primary question in terms of the ‘PICO’ framework (Population, Intervention/exposure, Control/comparator and Outcomes of interest) [43,44]. …”

“…The more similar the studies and their results, the more reasonable it is to pool them together for analysis [43,50]. The decision to combine studies should be based on both qualitative and quantitative evaluation.…”

“…1) [25,43], a forest plot depicting individual and most often an overall pooled estimate of effect (fig. 2) [26,43,68], and a funnel plot showing an assessment of publication bias (fig. 3).…”

Carotid Endarterectomy—The Evidence

“…There is, however, evidence that routine carotid patch closure reduces the risk of perioperative stroke and death. In addition, it reduces the late restenosis rate 19 (grade A evidence). A randomized trial from America has suggested that there is no signi®cant difference between vein, Dacron or polytetra¯uoroethylene as the patch material 20 .…”