title: Efficacy and safety of stenting for elderly patients with severe and symptomatic carotid artery stenosis: a critical meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To investigate both short-term and long-term therapeutic efficacy and safety of carotid artery stenting (CAS) and carotid artery endarterectomy (CEA) for elderly patients with severe and symptomatic carotid artery stenosis.
  
  
  METHODS
  PubMed, EMBASE, Cochrane Library, Clinical Trials Register Centers, and Google Scholar were comprehensively searched. After identifying relevant randomized controlled trials, methodological quality was assessed by using Cochrane tools of bias assessment. Meta-analysis was performed by RevMan software, and subgroup analyses according to different follow-up periods were also conducted.
  
  
  RESULTS
  Sixteen articles of nine randomized controlled trials containing 6,984 patients were included. Compared with CEA, CAS was associated with high risks of stroke during periprocedural 30 days (risk ratio [RR]=1.47, 95% confidence interval [CI]: 1.15-1.88), 48 months (RR=1.37, 95% CI: 1.11-1.70), and >48 months (RR=1.76, 95% CI: 1.34-2.31). There was no significant difference in the aspects of death, disabling stroke, or death at any time between the groups. For other periprocedural complications, CAS decreased the risk of myocardial infarction (RR=0.44, 95% CI: 0.26-0.75), cranial nerve palsy (RR=0.09, 95% CI: 0.04-0.22) and hematoma (RR=0.31, 95% CI: 0.14-0.68) compared with CEA, while it increased the risk of bradycardia or hypotension (RR=8.45, 95% CI 2.91-24.58).
  
  
  CONCLUSIONS
  Compared with CEA, CAS reduced hematoma, periprocedural myocardial infarction, and cranial nerve palsy, while it was associated with higher risks of both short-term and long-term nondisabling stroke. And they seemed to be equivalent in other outcome measures. As regards to its minimal invasion, it should be applied only in specific patients.
authors.affiliation: Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People's Republic of China.
authors.forename: Yi-An
authors.initials: YA
authors.lastname: Ouyang
authors.affiliation: Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People's Republic of China.
authors.forename: Yugang
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People's Republic of China.
authors.forename: Mengqiang
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People's Republic of China.
authors.forename: Yunze
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Second Xiang-Ya Hospital of Central South University, Changsha, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Huang
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology
keywords: carotid artery endarterectomy; carotid artery stenting; symptomatic carotid artery stenosis