title: Stenting versus endarterectomy for restenosis following prior ipsilateral carotid endarterectomy: an individual patient data meta-analysis.
abstract: 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.
authors: *Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands †Department of Vascular and Endovascular Surgery, Beth Israel Medical Center, Boston, MA ‡Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands §Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands; and ¶Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
authors: Margriet
authors: M
authors: Fokkema
authors: Joyce E P
authors: JE
authors: Vrijenhoek
authors: Hester M
authors: HM
authors: Den Ruijter
authors: Rolf H H
authors: RH
authors: Groenwold
authors: Marc L
authors: ML
authors: Schermerhorn
authors: Michiel L
authors: ML
authors: Bots
authors: Gerard
authors: G
authors: Pasterkamp
authors: Frans L
authors: FL
authors: Moll
authors: Gert Jan
authors: GJ
authors: De Borst
mesh_terms: D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006801:Humans; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000401:mortality; D013997:Time Factors