Carotid Endarterectomy Versus Carotid Artery Stenting With Embolic Protection Device For The Treatment Of Carotid Stenosis：a Meta-analysis

Objective:Carotid endarterectomy versus carotid angioplasty and stenting withembolic protection device for the treatment of carotid stenosis in meta-analysismethod to evaluate the short-term clinical efficacy and safety.Methods: We computer the electronic databases (PubMed, MEDLINE, EMbase,Cochrane Central Register of Controlled Trials, CNKI, Wanfang and VIP), handsearching as a supplement, in order to retrieve randomized controlled trials (RCTs)about comparing CEA and CAS with EPD for the treatment of carotid stenosis from2000to2013. Two researchers evaluated the quality of included studies together.Meta-analysis and data processing were done in the Rev. Man5.0software.Results: A total of six RCTs and3770patients (1873patients were randomized toCEA,1897patients were randomized to CAS with EPD) were included in the metaanalysis.(1) there was significant difference between CAS group and CEA group inthe stroke rate within30days after the procedures (OR=0.55,95%CI:0.38~0.79,P=0.001).(2) there was significant difference between CAS and CEA in the combinedstroke and death rate within30days after the procedures (OR=0.59,95%CI:0.43~0.82,P=0.002).(3) there was significant difference between CAS group and CEA group inthe cranial nerve injury rate within30days after the procedures (OR=11.34,95%CI:5.60~23.00, P﹤0.00001).(4) there was significant difference between CASgroup and CEA group in the myocardial infarction rate within30days after theprocedures (OR=2.18,95%CI:1.28~3.71, P=0.004).Conclusions: The available clinical data indicate that except for the lower morbidity of canial nerve injury and the myocardial infarction, the short-term efficacy andsafety of CAS+EPD in the treatment of carotid stenosis is not superior to CEA. CEAis still the first choice for the treatment of carotid stenosis in the context of correnttechnique. The results of ongoing randomized contolled clinical trials of this area willlikely provide additional evidences to support the choice of treatment for carotidstenosis.