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Stent-supported angioplasty versus endarterectomy for carotid artery stenosis

Evidence from current randomized trials

Stentgestützte Ballondilatation versus Endarterektomie zur Behandlung von Stenosen der Arteria carotis: Ergebnisse der randomisierten Studien

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Zusammenfassung

Hintergrund

Die meist stentgestützte Ballondilatation (CAS) von Stenosen der Arteria carotis entwickelt sich zunehmend zu einer Alternative der Carotisendarterektomie (CEA). Der Stellenwert der CAS im Vergleich zur CEA ist jedoch noch umstritten. Deswegen führten wir eine Meta-Analyse der randomisierten Studien (RCT) zu diesem Thema durch.

Methoden

Die RCTs wurden über eine MEDLINE Suche, Textbücher und durch persönliche Kontakte identifiziert.

Ergebnisse

Es fanden sich 6 abgeschlossene RCTs zu diesem Thema mit insgesamt 1263 Patienten, 628 randomisiert zu CAS und 635 zu CEA. Die 30 Tage Tod- oder Apoplexrate betrug bei den CAS-Patienten 8,0% (50/628) und bei den CEA-Patienten 6,1% (39/635) (OR=1,36, 95% CI: 0,88–2,11; p=0,17; p für Heterogenität= 0,009). Die Hirnnervenlähmungsrate betrug 7,1% in der CEA-Gruppe im Vergleich zu 0% in der CAS-Gruppe (p<0,0001). Die Myokardinfarktrate wurde von 3,1% auf 1% (OR=0,32, 95% CI: 0,12–0,81; p=0,02; p für Heterogenität=0,49) reduziert. Während der Nachbeobachtungszeit lag die Tod- oder Apoplexrate bei 12,1% bei den CAS-Patienten verglichen mit 12,2% bei den CEA-Patienten (OR=0,99, 95% CI: 0,70–1,42; p=0,98; p für Heterogenität=0,02).

Schlussfolgerung

Die verfügbaren Daten aus den RCT zum Vergleich des CAS versus der CEA zeigen eine gleiche Effektivität bezüglich akuter und mittelfristiger Ergebnisse (Tod/Apoplex) beider Methoden. Das CAS ist jedoch mit weniger sonstigen Komplikationen behaftet. Da jedoch eine signifikante Heterogenität bei den Studienergebnissen vorlag, sollten die Ergebnisse der großen RCTs zum Vergleich beider Methoden abgewartet werden, bevor das CAS als Standartverfahren zur Behandlung von Carotisstenosen propagiert wird.

Summary

Background

Carotid artery stenting (CAS) for carotid artery stenoses is evolving as an alternative to carotid endarterectomy (CEA). However, the value of CAS is still a matter of debate. Therefore, we performed a metaanalysis of the randomized controlled clinical trials (RCT) on this issue.

Methods

RCTs were identified through searching MEDLINE, textbooks and by personal communication.

Results

Six finished RCTs on this issue could be identified, including 1263 patients, 628 randomized to CAS and 635 to CEA. The 30-day death or stroke rate was 8.0% (50/628) in patients treated with CAS compared to 6.1% (39/635) in CEA patients (OR=1.36, 95% CI: 0.88–2.11; p=0.17; p for heterogeneity=0.009). The rate of cranial nerve palsy was 7.1% in the CEA compared to 0% in the CAS group (p<0.0001). The rate of myocardial infarctions was reduced from 3.1 to 1% (OR=0.32, 95% CI: 0.12– 0.81; p=0.02; p for heterogeneity=0.49). The death or stroke rate during follow-up was 12.1% in patients treated with CAS compared to 12.2% in CEA patients (OR=0.99, 95% CI: 0.70–1.42; p=0.98; p for heterogeneity=0.02).

Conclusion

The available RCT data on CAS vs. CEA suggest that both methods seem to be equally effective concerning short- and medium-term results, while CAS is associated with lower minor complications than CEA. However, because of the significant heterogeneity between the study outcomes, the results of the large RCTs underway should be awaited before it can be advised to use CAS in a broader perspective.

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Authors and Affiliations

  1. Herzzentrum Ludwigshafen, Kardiologie, Bremserstr. 79, 67063, Ludwigshafen, Germany

    R. Zahn, M. Hochadel & J. Senges

  2. Städtisches Klinikum, Neurologie, Bremserstr. 79, 67063, Ludwigshafen, Germany

    A. Grau

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  1. R. Zahn
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  2. M. Hochadel
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  3. A. Grau
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Correspondence to R. Zahn.

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Zahn, R., Hochadel, M., Grau, A. et al. Stent-supported angioplasty versus endarterectomy for carotid artery stenosis. ZS Kardiologie 94, 836–843 (2005). https://doi.org/10.1007/s00392-005-0311-5

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  • DOI: https://doi.org/10.1007/s00392-005-0311-5

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