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Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data

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Abstract

Stent-protected angioplasty of carotid artery stenosis may be an alternative to surgical endarterectomy. Results published so far are indecisive, with evidence both in favour of and against this procedure. After the recent publication of two large European multicentre trials (SPACE and EVA-3S) almost 3,000 patients have been included in randomized studies. For this report, we therefore conducted a systematic review of randomized studies that compared endovascular treatment with surgery for carotid stenosis. We evaluated seven trials including 2,973 patients. In our meta-analysis endovascular treatment seemed to carry a slightly higher risk for stroke or death within 30 days after the procedure as compared with surgery (8.2% vs. 6.2%; p = 0.04; OR 1.35), whereas the rates of disabling stroke or death within 30 days did not differ significantly (p = 0.47; n.s.). On the other hand, surgery carried a significantly higher risk for cranial nerve palsy (4.7% vs. 0.2%; p < 0.0001; OR 0.17) and myocardial infarction (2.3% vs. 0.9%; p = 0.03; OR 0.37). Long-term effects of both methods still need to be evaluated. Two other large multicentre trials (ICSS and CREST) are ongoing. Results of these studies will increase the database to about 7,000 randomized patients. Future meta-analyses should then allow definitive treatment recommendations.

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Authors and Affiliations

  1. Department of Neuroradiology, University of Munich, Munich, Germany

    Martin Wiesmann, Veronika Schöpf & Hartmut Brückmann

  2. Department of Neuroradiology, UKSH Campus Kiel, Kiel, Germany

    Olav Jansen

  3. Abteilung für Neuroradiologie, Klinikum der Universität München – Großhadern, Marchioninistr. 15, 81377, München, Germany

    Martin Wiesmann

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  1. Martin Wiesmann
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  2. Veronika Schöpf
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  3. Olav Jansen
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  4. Hartmut Brückmann
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Correspondence to Martin Wiesmann.

Additional information

The publication of first results from the SPACE study [1] has fuelled a controversial debate as to whether endovascular treatment of severe carotid artery stenosis constitutes an alternative to surgical endarterectomy—the gold-standard method so far. This article first reviews all randomized trials comparing endovascular treatment of carotid artery stenosis with surgery. In a meta-analysis the safety and efficacy of both methods are compared. Some questions arising from SPACE are then discussed separately.

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Wiesmann, M., Schöpf, V., Jansen, O. et al. Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. Eur Radiol 18, 2956–2966 (2008). https://doi.org/10.1007/s00330-008-1077-8

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  • DOI: https://doi.org/10.1007/s00330-008-1077-8

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