title: Eversion versus conventional carotid endarterectomy: a meta-analysis of randomised and non-randomised studies.
abstract: BACKGROUND
  To compare eversion (ECEA) and conventional (CCEA) carotid endarterectomy from randomised and non-randomised studies.
  
  
  METHODS
  Pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) and numbers needed to treat (NNTs) were appropriately calculated. A sub-analysis was performed on studies directly comparing ECEA vs. patch CEA (PCEA). Meta-regression analysis was performed to examine the effect of potentially meaningful patient-related, procedure-related and definition-related modifiers. Power calculations were also conducted.
  
  
  RESULTS
  A total of 21 studies were deemed eligible (8530 ECEA and 7721 CCEA procedures), seven of which were randomised and 14 non-randomised. ECEA was associated with significant reduction in perioperative stroke (OR = 0.46, 95%CI: 0.35-0.62, NNT = 68, 95%CI: 56-96), death (OR = 0.49, 95%CI: 0.34-0.69, NNT = 100, 95%CI: 85-185) and stroke-related death (OR = 0.40, 95%CI: 0.23-0.67, NNT = 147, 95%CI: 115-270); the results were replicated at the sub-analysis on PCEA. Concerning long-term outcomes, ECEA presented with a significant reduction in late carotid artery occlusion (OR = 0.48, 95%CI: 0.25-0.90, NNT = 143, 95%CI: 100-769) and late mortality (OR = 0.76, 95%CI: 0.61-0.94, NNT = 40, 95%CI: 25-167); the sub-analysis on PCEA replicated only the finding on late mortality. Meta-regression analysis did not point to significant effects mediated by the examined modifiers. Power calculations suggested adequate statistical power.
  
  
  CONCLUSIONS
  ECEA compared to CCEA may be associated with a lower incidence in both short-term and long-term outcomes, which does not seem to be hampered by potentially meaningful modifiers.
authors: Department of Vascular Surgery, University Hospital Attikon, Athens University Medical School, Greece. kostas.antonopoulos@gmail.com
authors: C N
authors: CN
authors: Antonopoulos
authors: J D
authors: JD
authors: Kakisis
authors: T N
authors: TN
authors: Sergentanis
authors: C D
authors: CD
authors: Liapis
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D016001:Confidence Intervals; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D061366:Numbers Needed To Treat; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis