Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Mid-Term Meta-Analysis Results of Carotid Artery Stenting and Carotid Endarterectomy Based on Randomized Controlled Studies
Randomize Kontrollü Çalışmalara Dayalı Karotis Arter Stentleme ve Karotis Endarterektominin Orta Dönem Metaanalizi Bulguları
İzzet AYDEMİRa , İhsan DOĞANb , Afsun Ezel ESATOĞLUc
aDepartment of Health Management, Bingöl University Faculty of Health Science, Bingöl, Türkiye
bDepartment of Neurosurgery, Ankara University Faculty of Medicine, Ankara, Türkiye
cDepartment of Health Management, Ankara University Faculty of Health Science, Ankara, Türkiye
Turkiye Klinikleri J Health Sci. 2023;8(3):487-96
doi: 10.5336/healthsci.2023-95693
Article Language: EN
Full Text
ABSTRACT
 Objective: A comprehensive of published randomized controlled trials (RCTs) was performed to evaluate the mid-term safety of carotid artery stenting (CAS) versus carotid endarterectomy (CEA) for both asymptomatic and asymptomatic carotid stenosis. Material and Methods: In this research, trails published from 1994 until December 31, 2021 was performed using ScienceDirect, Pubmed, Web of Science, Sage, Ebscohost, Scopus and Cochrane Central electronic databases. Major end points (any stroke, myocardial infarction, and all-cause mortality) were extracted from the publications. We calculated pooled risk ratios (RRs) and 95% confidence intervals (CIs) using a fixed-effects model. The Q and I2 statistic were used as a measure of heterogeneity. Results: Twelve trials involving 8,301 (4,498 with CAS; 3,803 with CEA) patients were included in the meta-analysis. When compared with CAE, stenting was associated with a significantly increased risk of mid-term any stroke (RR=1.397; 95% CI: 1.159-1.684; p<0,001) but a significantly decreased risk of mid-term myocardial infarction (RR=0,487; 95% CIs: 0.302-0.786; p=0,003). No difference was found in mid-term allcause mortality (RR=1,009; 95% CIs: 0.904-1.126; p=0,869) between the 2 interventions, yet with a minor trend toward superiority favoring CEA. No evidence of significant heterogeneity was found in any of the analysis. Conclusion: CAE was found to be superior to stenting in term of any stroke, whereas CAS was associated with a lower risk of mid-term myocardial infarction. But for robust results, further studies are needed to address the relative effectiveness of CAS versus CAE in the future.

Keywords: Carotid stenosis; meta-analysis; randomized control trials
ÖZET
 Amaç: Bu araştırmada, yayımlanmış randomize kontrollü çalışmaların (RKÇ) sonuçları kullanılarak semptomatik veya asemptomatik karotis stenozou tedavisinde kullanılan karotis arter stentleme (KAS) ve karotis endarterektomi (KAE) yöntemlerinin orta dönem meta-analitik sonuçları değerlendirilmiştir. Gereç ve Yöntemler: Araştırmada ScienceDirect, Pubmed, Web of Science, Sage, Ebscohost, Scopus ve Cochrane Central elektronik veri tabanları kullanılarak, 1994 yılından 31 Aralık 2021 tarihine kadar yayımlanan RKÇ'ler analiz edilmiştir. Araştırmada tedavi sonrası yöntemlerin; inme, miyokard infarktüsü ve tüm ölüm nedeni değerlendirilmiştir. Risk Oranı (RO) ölçütü seçilerek hesaplanan etki büyüklüğü, Sabit Etkiler Modeli kullanılarak %95 güven aralığında (GA) hesaplanmıştır. Q ve I2 istatistikleri verilerin heterojenlik varsayımlarında ve verilerin analizinde kullanılmıştır. Bulgular: Toplam 8.301 (KAS=4.498; KAE=3.803) hastayı içeren 12 çalışma analize dâhil edilmiştir. KAE ile karşılaştırıldığında KAS yöntemi, orta dönem inme riskinde istatistiksel olarak önemli bir atış ile sonuçlanırken [risk oranı ''risk ratio (RR)''=1,397; %95 GA: 1,159-1,684; p<0,001]; tam tersine miyokard infarktüsü bakımından istatistiksel bir azalma ile sonuçlanmıştır (RR=0,487; %95 GA: 0,302-0,786; p=0,003). Araştırmada, orta dönem tüm nedenlere bağlı ölüm oranlarında (RR=1,009; %95 GA: 0,904-1,126; p=0,869) 2 müdahale arasında hiçbir fark bulunmazken, elde edilen sonuç KAE lehine olmuştur. Analizde homojenlik varsayımları sağlanmıştır. Sonuç: Araştırmada, inme ve miyokard infarktüsü bakımından tedavi yöntemleri farklı sonuçlar üretirken, tüm ölüm nedenleri bakımından bir fark gözlenmemiştir. Tedavi yöntemlerinin birbirlerinin alternatifi olmaktan ziyade birbirlerini tamamlayan yöntemler olarak kullanılması önerilmektedir.

Anahtar Kelimeler: Karotis stenozu; metaanalizi; randomize kontrollü çalışmalar
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