title: Long term durability and outcomes of carotid stenting and carotid endarterectomy.
abstract: OBJECTIVE
  To evaluate the long term durability and outcomes of carotid angioplasty and stenting (CAS) compared with carotid endarterectomy (CEA).
  
  
  METHODS
  Using multiple comprehensive databases, we searched for randomized controlled trials comparing CAS with CEA for carotid stenosis. Studies were classified according to symptom status: symptomatic, asymptomatic, or all inclusive stenosis. Postprocedural ipsilateral stroke, restenosis/occlusion after revascularization, procedural stroke/death/myocardial infarction (MI), and postprocedural ipsilateral stroke were evaluated. Subgroup analysis was performed according to follow-up duration.
  
  
  RESULTS
  22 studies were included and classified for meta-analyses in relation to specific outcomes. The maximum follow-up duration was 10 years. The risk of postprocedural ipsilateral stroke in CEA was equivalent to that in CAS, irrespective of symptom status or follow-up time points. The CAS group had a greater risk of restenosis/occlusion after revascularization compared with CEA in studies of all inclusive stenosis. A similar tendency was found in studies of symptomatic stenosis, but without statistical significance. However, subgroup analysis showed that the risk of restenosis/occlusion in CAS decreased gradually with time, to the extent that these risks became comparable 1 year after the procedure. Procedural stroke/death/MI and postprocedural ipsilateral stroke occurred more frequently in the CAS group in studies of symptomatic stenosis although not in studies of asymptomatic or all inclusive stenosis. However, this association did not persist when studies were divided according to follow-up time points.
  
  
  CONCLUSIONS
  Although CAS may be more strongly associated with periprocedural stroke/death compared with CEA, it could be a good alternative to CEA in terms of long term durability and outcomes.
authors.affiliation: Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
authors.forename: Jin-Man
authors.initials: JM
authors.lastname: Jung
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.|Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Suh
authors.affiliation: Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea.|Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Woo-Keun
authors.initials: WK
authors.lastname: Seo
mesh_terms: D017130:Angioplasty / Q000592:standards / Q000639:trends; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016208:Databases, Factual / Q000639:trends; D016894:Endarterectomy, Carotid / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D015607:Stents / Q000592:standards / Q000639:trends*; D020521:Stroke / Q000453:epidemiology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Angioplasty; Atherosclerosis; Intervention