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Annals of Surgery:
doi: 10.1097/SLA.0000000000000799
Original Article: PDF Only

Stenting Versus Endarterectomy for Restenosis Following Prior Ipsilateral Carotid Endarterectomy: An Individual Patient Data Meta-analysis.

Fokkema, Margriet MD; Vrijenhoek, Joyce E. P. MD; Den Ruijter, Hester M. PhD; Groenwold, Rolf H. H. MD, PhD; Schermerhorn, Marc L. MD; Bots, Michiel L. MD, PhD; Pasterkamp, Gerard MD, PhD; Moll, Frans L. MD, PhD; De Borst, Gert Jan MD, PhD

Published Ahead-of-Print
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Objective: To study perioperative results and restenosis during follow-up of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for restenosis after prior ipsilateral CEA in an individual patient data (IPD) meta-analysis.

Background: The optimal treatment strategy for patients with restenosis after CEA remains unknown.

Methods: A comprehensive search of electronic databases (Medline, Embase) until July 1, 2013, was performed, supplemented by a review of references. Studies were considered for inclusion if they reported procedural outcome of CAS or CEA after prior ipsilateral CEA of a minimum of 5 patients. IPD were combined into 1 data set and an IPD meta-analysis was performed. The primary endpoint was perioperative stroke or death and the secondary endpoint was restenosis greater than 50% during follow-up, comparing CAS and CEA.

Results: In total, 13 studies were included, contributing to 1132 unique patients treated by CAS (10 studies, n = 653) or CEA (7 studies; n = 479). Among CAS and CEA patients, 30% versus 40% were symptomatic, respectively (P < 0.01). After adjusting for potential confounders, the primary endpoint did not differ between CAS and CEA groups (2.3% vs 2.7%, adjusted odds ratio 0.8, 95% confidence interval (CI): 0.4-1.8). Also, the risk of restenosis during a median follow-up of 13 months was similar for both groups (hazard ratio 1.4, 95% (CI): 0.9-2.2). Cranial nerve injury (CNI) was 5.5% in the CEA group, while CAS was in 5% associated with other procedural related complications.

Conclusions: In patients with restenosis after CEA, CAS and CEA showed similar low rates of stroke, death, and restenosis at short-term follow-up. Still, the risk of CNI and other procedure-related complications should be taken into account.

(C) 2015 by Lippincott Williams & Wilkins.