title: Meta-Analysis of Randomized Controlled Trials Comparing the Long-Term Outcomes of Carotid Artery Stenting Versus Endarterectomy.
abstract: BACKGROUND
  Stenting is an endovascular alternative to endarterectomy for the management of carotid stenosis, but its long-term safety and efficacy relative to endarterectomy remain unclear. Our objective was to compare the safety and efficacy of stenting with those of endarterectomy, with a particular focus on long-term outcomes, via meta-analysis of randomized controlled trials (RCTs).
  
  
  RESULTS
  We systematically searched PubMed, EMBASE, MEDLINE, and the Cochrane Library for RCTs with ≥50 patients that compared stenting with endarterectomy in patients with carotid stenosis. Periprocedural and long-term outcomes were assessed, with data pooled across RCTs using random-effects models. Eight RCTs were included in our meta-analysis (n=7091), with follow-up ranging from 2.0 to 10.0 years. When compared with endarterectomy, stenting was associated with an increased risk of periprocedural stroke (relative risk, 1.49, 95% confidence interval [CI], 1.11 to 2.01; risk difference, 1.7%; 95% CI, 0.3 to 3.0) but a decreased risk of periprocedural myocardial infarction (relative risk, 0.47; 95% CI, 0.29 to 0.78; risk difference, -0.4%; 95% CI, -0.8% to 0.1%). During long-term follow-up, stenting was associated with an increased risk of stroke (relative risk, 1.36; 95% CI, 1.16 to 1.61) and a composite end point of ipsilateral stroke, periprocedural stroke, or periprocedural death (relative risk, 1.45; 95% CI, 1.20 to 1.75).
  
  
  CONCLUSIONS
  Although stenting has more favorable periprocedural outcomes with respect to myocardial infarction, the observed increased risk of stroke and death throughout follow-up with stenting suggests that endarterectomy remains the treatment of choice for carotid stenosis.
authors.affiliation: From the Center for Clinical Epidemiology, Lady Davis Institute (S.V., M.E., M.J.E., K.B.F.) and Division of Cardiology (M.J.E.), Jewish General Hospital, Montreal, Quebec, Canada; and Faculty of Medicine (S.V., M.J.E., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), Division of Cardiology (M.J.E.), and Division of Clinical Epidemiology, Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vincent
authors.affiliation: From the Center for Clinical Epidemiology, Lady Davis Institute (S.V., M.E., M.J.E., K.B.F.) and Division of Cardiology (M.J.E.), Jewish General Hospital, Montreal, Quebec, Canada; and Faculty of Medicine (S.V., M.J.E., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), Division of Cardiology (M.J.E.), and Division of Clinical Epidemiology, Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Eberg
authors.affiliation: From the Center for Clinical Epidemiology, Lady Davis Institute (S.V., M.E., M.J.E., K.B.F.) and Division of Cardiology (M.J.E.), Jewish General Hospital, Montreal, Quebec, Canada; and Faculty of Medicine (S.V., M.J.E., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), Division of Cardiology (M.J.E.), and Division of Clinical Epidemiology, Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: From the Center for Clinical Epidemiology, Lady Davis Institute (S.V., M.E., M.J.E., K.B.F.) and Division of Cardiology (M.J.E.), Jewish General Hospital, Montreal, Quebec, Canada; and Faculty of Medicine (S.V., M.J.E., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), Division of Cardiology (M.J.E.), and Division of Clinical Epidemiology, Department of Medicine (K.B.F.), McGill University, Montreal, Quebec, Canada. kristian.filion@mcgill.ca.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: carotid stenosis; endarterectomy, carotid; meta-analysis; myocardial infarction; randomized controlled trial