title: Carotid artery stenting versus carotid endarterectomy: a comprehensive meta-analysis of short-term and long-term outcomes.
abstract: OBJECTIVE
  The comparison between carotid endarterectomy and carotid artery stenting (CAS) remains a debated field, especially in the context of long-term outcomes.
  
  
  METHODS
  Concerning the short-term (30-day) analysis, the numbers of outcomes per arm were abstracted, whereas outcomes per arm and hazard ratios were abstracted for long-term (≥1-year) results.
  
  
  RESULTS
  Thirteen randomized trials (3723 carotid endarterectomy and 3754 CAS patients) were eligible. Regarding short-term outcomes, CAS was associated with elevated risk for stroke and "death or stroke." CAS also exhibited a marginal trend toward higher death and "death or disabling stroke" rates. Carotid endarterectomy presented with higher rates of myocardial infarction and cranial nerve injury. Concerning long-term outcomes, CAS was associated with higher rates of stroke (pooled OR, 1.37; 95% CI, 1.13 to 1.65) and "death or stroke" (pooled OR, 1.25; 95% CI, 1.06 to 1.48). These findings were replicated at the level of pooled hazard ratios and marginally regarding secondary preventive efficacy. The difference in long-term stroke rates was particularly sizeable in patients >68 years, but little difference in rates was observed in those <68 years. No statistically significant heterogeneity became evident. Metaregression did not reveal any significant modifying effect mediated by symptomatic/asymptomatic status, distal protection, early termination of trials, area of study origin, or CAS learning curve.
  
  
  CONCLUSIONS
  This meta-analysis points to the significantly less frequent stroke events after carotid endarterectomy at the long-term context. The outcomes of carotid endarterectomy seem superior to CAS, but there may be subgroups, particularly younger patients, in whom the results seem equivalent.
authors.affiliation: School of Medicine, University of Athens, 5 Menalou, Maroussi, Athens, Greece. economopoulos@sni.gr
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Economopoulos
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Anargiros D
authors.initials: AD
authors.lastname: Mariolis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D016893:Carotid Stenosis / Q000453:epidemiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000639:trends*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D015607:Stents / Q000009:adverse effects / Q000639:trends*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome