Carotid Artery Stenting versus Carotid Endarterectomy in Terms of Neuroprotection DW-MRI Detected and Neuropsychological Assessment Impairment

Gabrielli, Roberto; Siani, Andrea; Smedile, Gianluca; Rizzo, Anna Rita; Accrocca, Federico; Bartoli, Stefano

doi:10.1016/j.avsg.2023.05.046

Cited by 2 publications

(9 citation statements)

References 32 publications

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“…Of the 25 included studies in the final analysis, 22 were non-randomized studies 33,40,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][58][59][60][61][62][63] (7 retrospective and 15 prospective) and 3 were randomized controlled trials 27,42,57 . In 1 of the 22 non-randomized studies, the propensity score matching technique was used to adjust preoperative patients' demographic and comorbidity data 40 .…”

Section: Study Quality and Publication Bias Assessmentmentioning

confidence: 99%

“…The overall stroke rate was available in 17 studies including 28 stroke events after CEA (1.6%, 23/1429) and versus 53 events in the CAS group (4.7%, 53/1124) 27,[43][44][45][46][47]49,51,52,[54][55][56][57][58][59]61,62 . The stroke rate was significantly lower in CEA group compared to CAS technique (OR: 0.38, 95% CI: 0.23-0.63, p<0.001).…”

Section: Strokementioning

confidence: 99%

“…The MRI was performed within 72 hours after the procedure in 22 studies 27,33,40,[42][43][44][45][46][47][48][49][50][51][54][55][56][57][59][60][61][62][63] . The incidence of new cerebral ischemic lesions was significantly lower after the CEA procedures (13.6%, 237/1738) compared to CAS (40.4%, 567/1404) (OR: 0.25, 95% CI 0.18-0.36, p<0.001).…”

Section: -Hours Post-proceduresmentioning

confidence: 99%

“…The presence of pre-operative symptoms was expressed as the difference in rates of occurrence in the CEA versus the CAS group, and data were extracted from 19 studies 27,40,[44][45][46][47]49,[51][52][53][54][55][56][57][58][59][61][62][63] . Meta-regression analysis revealed that the presence of pre-operative symptoms had no statistically significant influence on the incidence of new cerebral ischemic lesions (p=0.241) (Supplemental Figure 11).…”

Section: Meta-regression Analysismentioning

confidence: 99%

“…Meta-regression analysis revealed that the presence of pre-operative symptoms had no statistically significant influence on the incidence of new cerebral ischemic lesions (p=0.241) (Supplemental Figure 11). The data regarding hypertension were available in 15 studies 27,40,[44][45][46]48,51,52,[54][55][56][57]59,62,63 , and no statistically significant influence was found in the presence of hypertension and the rate of newly detected lesions (p=0.134) (Supplemental Figure 12). The occurrence rates of diabetes and smoking were extracted from 15 studies 27,40,[44][45][46]48,51,52,[54][55][56][57]59,62,63 and 13 studies 27,40,[44][45][46]51,52,56,57,59,[61][62][63] , respectively, and no statistically significant influence was detected between smoking (p=0.913) and diabetes (p=0.881) in the incide...…”

Section: Meta-regression Analysismentioning

confidence: 99%

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Ischemic cerebral lesions after Carotid Stenting versus Carotid Endarterectomy: A Systematic review and Meta-Analysis

Loufopoulos,

Manaki,

Tasoudis

et al. 2024

Preprint

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BackgroundRecent randomized controlled trials have demonstrated similar outcomes in terms of ischemic stroke incidence after carotid endarterectomy (CEA) or carotid artery stenting (CAS) in asymptomatic carotid disease, while CEA seems to be the first option for symptomatic carotid disease. The aim of this meta-analysis is to assess incidence of silent cerebral microembolization detected by Magnetic Resonance Imaging (MRI) following these procedures.MethodsA systematic search was conducted using PubMed, Scopus and Cochrane databases including comparative studies involving symptomatic or asymptomatic patients undergoing either CEA or CAS, and reporting on new cerebral ischemic lesions in post-operative MRI. The primary outcome was the newly detected cerebral ischemic lesions. Pooled effect estimates for all outcomes were calculated using the random-effects model. Pre-specified random effects meta-regression and subgroup analysis were conducted to examine the impact of moderator variables on the presence of new cerebral ischemic lesions.Results25 studies reporting on total 1827 CEA and 1500 CAS interventions fulfilled the eligibility criteria. The incidence of new cerebral ischemic lesions was significantly lower after CEA comparing to CAS, regardless of the time of MRI assessment (first 24 hours; OR: 0.33, 95% CI: 0.17-0.64, p<0.001), (the first 72 hours, OR: 0.25, 95% CI 0.18-0.36, p<0.001), (generally within a week after the operation; OR: 0.24, 95% CI: 0.17-0.34, p<0.001). Also, the rate of stroke (OR: 0.38, 95% CI: 0.23-0.63, p<0.001) and the presence of contralateral new cerebral ischemic lesions (OR: 0.16, 95% CI 0.08-0.32, p<0.001) were less frequent after CEA. Subgroup analysis based on the study design and the use of embolic protection device during CAS showed consistently lower rates of new lesions after CEA.ConclusionsCEA demonstrates significant lower rates of new silent cerebral microembolization, as detected by MRI in postoperative period, compared to CAS.

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