Systematic comparison of the early outcome of angioplasty and endarterectomy for symptomatic carotid artery disease.
OBJECTIVE
Endoluminal treatment is being increasingly used for carotid artery disease. The aim of this study was to compare the stroke and death risk within 30 days of endovascular treatment or endarterectomy for symptomatic carotid artery disease.


METHODS
systematic comparison of the 30-day outcome of angioplasty with or without stenting and endarterectomy for symptomatic carotid artery disease reported in single-center studies, published since 1990, was performed.


RESULTS
Thirty-three studies (13 angioplasty and 20 carotid endarterectomy) were included in this analysis. Carotid stents were deployed in 44% of angioplasty patients. Mortality within 30 days of angioplasty was 0.8% compared with 1.2% after endarterectomy (OR 0.68, 95% CI 0.43 to 1.05; P=0.6). The stroke rate was 7.1% for angioplasty and 3.3% for endarterectomy (OR 2.22, CI 1.62 to 3.04; P<0.001), while the risk of fatal or disabling stroke was 3.2% and 1.6%, respectively (OR 2.09, CI 1.3 to 3.33; P<0.01). The risk of stroke or death was 7.8% for angioplasty and 4% for endarterectomy (OR 2.02, CI 1.49 to 2.75; P<0.001), while disabling stroke or death was 3.9% after angioplasty and 2.2% after endarterectomy (OR 1.86, CI 1.22 to 2.84; P<0.01).


CONCLUSIONS
In the treatment of symptomatic carotid artery disease, the risk of stroke is significantly greater with angioplasty than carotid endarterectomy. At present, carotid angioplasty is not recommended for the majority of patients with symptomatic carotid artery disease.
Golledge
J
J
Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, UK. J.Golledge@tesco.net
Mitchell
A
A
Greenhalgh
R M
RM
Davies
A H
AH
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000706:statistics & numerical data; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D002986:Clinical Trials as Topic; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014711:Vertebral Artery