section name header

Evidence summaries

Carotid Artery Stenting Vs Endarterectomy for Carotid Artery Stenosis

Carotid stenting is as effective as endarterectomy in preventing recurrent stroke in symptomatic carotid stenosis but associated with a higher risk of periprocedural stroke or death than endarterectomy. Combining procedural safety and long-term efficacy in preventing recurrent stroke favours endarterectomy. Stenting for asymptomatic carotid stenosis carries a small increase in the risk of periprocedural stroke or death compared with endarterectomy. Level of evidence: "A"

A Cochrane review [Abstract]2 included 22 studies with a total of 9753 patients.

  • The patients with symptomatic carotid stenosis: Stenting was associated with a higher risk of periprocedural death or stroke (the primary safety outcome; OR 1.70, 95% CI 1.31 to 2.19; 10 trials, n=5396); and periprocedural death, stroke, or myocardial infarction (OR 1.43, 95% CI 1.14 to 1.80; 6 trials, n=4861). The OR for the primary safety outcome was 1.11 (95% CI 0.74 to 1.64) in patients under 70 years old and 2.23 (95% CI 1.61 to 3.08) in patents 70 years old or more (interaction p=0.007). There was a non-significant increase in periprocedural death or major or disabling stroke with stenting (OR 1.36, 95% CI 0.97 to 1.91; 7 trials, n=4983). Stenting was associated with lower risks of myocardial infarction (OR 0.47, 95% CI 0.24 to 0.94), cranial nerve palsy (OR 0.09, 95% CI 0.06 to 0.16), and access site haematoma (OR 0.32, 95% CI 0.15 to 0.68). The combination of periprocedural death or stroke or ipsilateral stroke during follow-up (the primary combined safety and efficacy outcome) favoured endarterectomy (OR 1.51, 95% CI 1.24 to 1.85; 8 trials, n=5080). The rate of ipsilateral stroke after the periprocedural period did not differ between treatments (OR 1.05, 95% CI 0.75 to 1.47).
  • The patients with asymptomatic carotid stenosis:, There was a non-significant increase in periprocedural death or stroke with stenting (OR 1.72, 95% CI 1.00 to 2.97; 7 trials, n=3378). The risk of periprocedural death or stroke or ipsilateral stroke during follow-up did not differ significantly between treatments (OR 1.27, 95% CI 0.87 to 1.84; 6 trials, n=3315). Moderate or higher carotid artery restenosis (50% or greater) or occlusion during follow-up was more common after stenting (OR 2.00, 95% CI 1.12 to 3.60; n=2015), but the difference in risk of severe restenosis was not significant (70% or greater; OR 1.26, 95% CI 0.79 to 2.00).

References

  • Müller MD, Lyrer P, Brown MM et al. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis. Cochrane Database Syst Rev 2020;2():CD000515. [PubMed]

Primary/Secondary Keywords