title: Quality of life and functional status after carotid revascularisation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Stroke causes significant quality of life (QOL) deterioration and functional impairment. Carotid revascularisation by either endarterectomy (CEA) or stenting (CAS) is performed to prevent stroke. The direct effect of revascularisation on QOL is unclear. This study reviews (a) QOL after CEA, (b) QOL after CAS, (c) QOL differences between CEA and CAS, and (d) QOL compared with reference populations.
  
  
  METHODS
  Medline and Embase were used for sources of data. The PRISMA guidelines were followed. Clinical studies published after January 1990 were selected using strict eligibility criteria. Quality appraisal and data tabulation were performed using predetermined forms. Data were synthesised by narrative review and random-effects meta-analysis using standardised response means. Heterogeneity and bias were assessed.
  
  
  RESULTS
  Twelve studies (4,224 patients), including two randomised controlled trials, were reviewed. Despite an initial decline in QOL after CEA, quantitative and qualitative analysis of the SF-36 questionnaire showed all domains returned to baseline by 1 year. Preliminary data suggests that QOL after CAS does not have an initial decline, especially in physical health domains. QOL is similar between CEA and CAS at 1 year. Comparisons to reference populations are inconclusive. Meta-analysis was limited by significant statistical and methodological heterogeneity.
  
  
  CONCLUSIONS
  Revascularisation by CEA or CAS maintains preoperative QOL. There are minimal differences between CEA and CAS. This review reaffirms the success of carotid revascularisation in preventing the devastating consequences of stroke on QOL and functional status. Guidelines for future studies are provided.
authors.affiliation: Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Australia. Electronic address: leonard.shan3001@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Shan
authors.affiliation: Faculty of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Shan
authors.affiliation: Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Vascular Surgery, St. Vincent's Hospital, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Robinson
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D011788:Quality of Life; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome
keywords: Carotid endarterectomy; Carotid stenosis; Carotid stenting; Quality of life; Stroke