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European Radiology

, Volume 18, Issue 12, pp 2956–2966 | Cite as

Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data

  • Martin WiesmannEmail author
  • Veronika Schöpf
  • Olav Jansen
  • Hartmut Brückmann
Neuro

Abstract

Stent-protected angioplasty of carotid artery stenosis may be an alternative to surgical endarterectomy. Results published so far are indecisive, with evidence both in favour of and against this procedure. After the recent publication of two large European multicentre trials (SPACE and EVA-3S) almost 3,000 patients have been included in randomized studies. For this report, we therefore conducted a systematic review of randomized studies that compared endovascular treatment with surgery for carotid stenosis. We evaluated seven trials including 2,973 patients. In our meta-analysis endovascular treatment seemed to carry a slightly higher risk for stroke or death within 30 days after the procedure as compared with surgery (8.2% vs. 6.2%; p = 0.04; OR 1.35), whereas the rates of disabling stroke or death within 30 days did not differ significantly (p = 0.47; n.s.). On the other hand, surgery carried a significantly higher risk for cranial nerve palsy (4.7% vs. 0.2%; p < 0.0001; OR 0.17) and myocardial infarction (2.3% vs. 0.9%; p = 0.03; OR 0.37). Long-term effects of both methods still need to be evaluated. Two other large multicentre trials (ICSS and CREST) are ongoing. Results of these studies will increase the database to about 7,000 randomized patients. Future meta-analyses should then allow definitive treatment recommendations.

Keywords

Angioplasty Carotid stenosis Endarterectomy Carotid stenting Stroke prevention 

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Copyright information

© European Society of Radiology 2008

Authors and Affiliations

  • Martin Wiesmann
    • 1
    • 3
    Email author
  • Veronika Schöpf
    • 1
  • Olav Jansen
    • 2
  • Hartmut Brückmann
    • 1
  1. 1.Department of NeuroradiologyUniversity of MunichMunichGermany
  2. 2.Department of NeuroradiologyUKSH Campus KielKielGermany
  3. 3.Abteilung für Neuroradiologie, Klinikum der Universität München – GroßhadernMünchenGermany

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