Introduction: Carotid endarterectomy versus carotid stenting—A never-ending story

Setacci, Carlo; Sterpetti, Antonio V.; Donato, Gianmarco de

doi:10.1053/j.semvascsurg.2018.03.001

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…Carotid endarterectomy (CEA), performed to prevent embolus, is considered a conventional treatment (Howell, 2007). Carotid artery stenting (CAS), a minimally invasive procedure (Spiliopoulos et al, 2019), has emerged as an effective treatment modality for carotid artery stenosis (Setacci et al, 2018). Although these two surgical interventions have improved the prognosis of ischemic stroke, they may carry hemorrhage as a severe complication (Spence et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications

et al. 2022

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Background: Protamine can decrease the risk of hemorrhage during carotid recanalization. However, it may cause severe side effects. There is no consensus on the safety and efficacy of protamine during surgery. Thus, we conduct a comprehensive review and meta-analysis to compare the differences between the protamine and the no-protamine group.Method: We systematically obtained literature from Medline, Google Scholar, Cochrane Library, and PubMed electronic databases. All four databases were scanned from 1937 when protamine was first adopted as a heparin antagonist until February 2021. The reference lists of identified studies were manually checked to determine other eligible studies that qualify. The articles were included in this meta-analysis as long as they met the criteria of PICOS; conference or commentary articles, letters, case report or series, and animal observation were excluded from this study. The Newcastle-Ottawa Quality Assessment Scale and Cochrane Collaboration’s tool are used to assess the risk of bias of each included observational study and RCT, respectively. Stata version 12.0 statistical software (StataCorp LP, College Station, Texas) was adopted as statistical software. When I2 < 50%, we consider that the data have no obvious heterogeneity, and we conduct a meta-analysis using the fixed-effect model. Otherwise, the random-effect model was performed.Result: A total of 11 studies, consisting of 94,618 participants, are included in this study. Our analysis found that the rate of wound hematoma had a significant difference among protamine and no-protamine patients (OR = 0.268, 95% CI = 0.093 to 0.774, p = 0.015). Furthermore, the incidence of hematoma requiring re-operation (0.7%) was significantly lower than that of patients without protamine (1.8%). However, there was no significant difference in the incidence of stroke, wound hematoma with hypertension, transient ischemic attacks (TIA), myocardial infarction (MI), and death.Conclusion: Among included participants undergoing recanalization, the use of protamine is effective in reducing hematoma without increasing the risk of having other complications. Besides, more evidence-based performance is needed to supplement this opinion due to inherent limitations.

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Section: Introductionmentioning

confidence: 99%

A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications

et al. 2022

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Periprocedural clinical outcomes of stenting and endarterectomy in patients with carotid artery stenosis

Özdoğru,

Uysal,

Öztürk

et al. 2024

Cukurova Medical Journal

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Purpose: To identify the chief pathological cause of extracranial cerebrovascular disease, which is atherosclerosis, we analyzed and compared the early and 6-month morbidity and mortality rates of patients who underwent carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis. Materials and Methods: We retrospectively included patients who had undergone surgical endarterectomy and endovascular carotid stent implantation for carotid artery stenosis between April 2019 and August 2022. We evaluated neurological examinations, routine blood tests, neurological and systemic complications, mortality rates, and follow-up colour Doppler ultrasonography 6 months post-discharge. Results: The study included a total of 300 patients, with 52.7% (n = 158) undergoing CEA and 47.3% (n = 142) undergoing endovascular stent implantation (CAS). The patients’ average ages were 66±8 years in the CEA group and 70±7.4 years in the CAS group, suggesting that those undergoing CAS were generally older. Notably, there were significantly more instances of congestive heart failure and a history of cerebrovascular disease within the CAS group compared to the CEA group. However, no significant difference was observed in the rates of postprocedural complications. Furthermore, there were no cases of mortality reported in either group. Conclusion: The preferred method for treating severe carotid artery stenosis should be determined by considering patient characteristics and preferences, as well as the complication rates in the centre.

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Introduction: Carotid endarterectomy versus carotid stenting—A never-ending story

Cited by 2 publications

References 19 publications

A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications

A Meta-Analysis of Using Protamine for Reducing the Risk of Hemorrhage During Carotid Recanalization: Direct Comparisons of Post-operative Complications

Periprocedural clinical outcomes of stenting and endarterectomy in patients with carotid artery stenosis

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