title: Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: Systematic review and meta-analysis.
abstract: OBJECTIVE
  Carotid restenosis (CRS) after carotid endarterectomy (CEA) is an issue that cannot be ignored. This study was undertaken to compare the outcomes of repeated CEA (redo CEA) and carotid artery stenting (CAS) for CRS after CEA.
  
  
  METHODS
  We performed a systematic analysis using the search terms "CEA restenosis," "carotid restenosis," or "CEA recurrent stenosis" in the MEDLINE, EMBASE, PubMed, and Cochrane Library databases. After applying the inclusion criteria, all available data were summarized to evaluate the effects of redo CEA and CAS for patients with CRS after prior CEA.
  
  
  RESULTS
  Fifty articles (9 comparative studies and 41 noncomparative studies) involving 4,399 patients were included. No differences were observed in the 30-day perioperative mortality, stroke and transient ischemic attack rates in the comparative studies (P > .05) and the noncomparative studies (P > .05). Patients undergoing redo CEA suffered more cranial nerve injuries (CNIs) than those undergoing CAS (P < .05), but most of these cases recovered within 3 months. Patients treated with redo CEA exhibited similar myocardial infarction (MI) rates to those treated with CAS in the comparative studies (P = .53), but the rate was higher in the noncomparative studies (P < .01). However, a nonsignificant difference was noted in freedom from stroke at 36 months in the comparative studies (P = .47) and at 12 months in the noncomparative studies (P = .89). The risk of restenosis was greater in the CAS patients than in the redo CEA patients (P < .05 for comparative and noncomparative studies).
  
  
  CONCLUSIONS
  Both redo CEA and CAS are safe and feasible for CRS after CEA. Although the incidences of CNI and MI were increased in the redo CEA group, most of the CNI cases were reversible. Patients treated with CAS were more likely to develop restenosis than those treated with redo CEA over long-term follow-up.
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China; 8-year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Tu
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China.
authors.forename: Siwen
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China; 8-year Program, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
authors.forename: Zijun
authors.initials: Z
authors.lastname: Huo
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China.
authors.forename: Ridong
authors.initials: R
authors.lastname: Wu
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China. Electronic address: yaochen_sums@163.com.
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou City, Guangzhou, China. Electronic address: shenming_wang@126.com.
authors.forename: Shenming
authors.initials: S
authors.lastname: Wang
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000379:methods*; D016893:Carotid Stenosis / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome