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Role of Carotid Artery Stenting in Prevention of Stroke for Asymptomatic Carotid Stenosis: Bayesian Cross-Design and Network Meta-Analyses

Korean Circulation Journal 2020년 50권 4호 p.330 ~ 342
노재형, 조현정, 이재환, Kim Yong-Ku, Park Yeong-Woo, 박재형, 박희순, 김민수, Jin Hyang-Gon, Cheon Ye-Ji, 성인환,
소속 상세정보
노재형 ( Roh Jae-Hyung ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
조현정 ( Cho Hyun-Jung ) - Daegu Fatima Hospital Department of Internal Medicine
이재환 ( Lee Jae-Hwan ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
 ( Kim Yong-Ku ) - Kyungpook National University Department of Statistics
 ( Park Yeong-Woo ) - Kyungpook National University Department of Statistics
박재형 ( Park Jae-Hyeong ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
박희순 ( Park Hee-Soon ) - Korea University Medical Center Anam Hospital Department of Internal Medicine
김민수 ( Kim Min-Su ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine
 ( Jin Hyang-Gon ) - Kyungpook National University Department of Statistics
 ( Cheon Ye-Ji ) - Kyungpook National University Department of Statistics
성인환 ( Seong In-Whan ) - Chungnam National University School of Medicine Chungnam National University Hospital Department of Internal Medicine

Abstract


Background and Objectives: There is insufficient evidence regarding the optimal treatment for asymptomatic carotid stenosis.

Methods: Bayesian cross-design and network meta-analyses were performed to compare the safety and efficacy among carotid artery stenting (CAS), carotid endarterectomy (CEA), and medical treatment (MT). We identified 18 studies (4 randomized controlled trials [RCTs] and 14 nonrandomized, comparative studies [NRCSs]) comparing CAS with CEA, and 4 RCTs comparing CEA with MT from MEDLINE, Cochrane Library, and Embase databases.

Results: The risk for periprocedural stroke tended to increase in CAS, compared to CEA (odds ratio [OR], 1.86; 95% credible interval [CrI], 0.62?4.54). However, estimates for periprocedural myocardial infarction (MI) were quite heterogeneous in RCTs and NRCSs. Despite a trend of decreased risk with CAS in RCTs (OR, 0.70; 95% CrI, 0.27?1.24), the risk was similar in NRCSs (OR, 1.02; 95% CrI, 0.87?1.18). In indirect comparisons of MT and CAS, MT showed a tendency to have a higher risk for the composite of periprocedural death, stroke, MI, or nonperiprocedural ipsilateral stroke (OR, 1.30; 95% CrI, 0.74?2.73). Analyses of study characteristics showed that CEA-versus-MT studies took place about 10-year earlier than CEA-versus-CAS studies.

Conclusions: A similar risk for periprocedural MI between CEA and CAS in NRCSs suggested that concerns about periprocedural MI accompanied by CEA might not matter in real-world practice when preoperative evaluation and management are working. Maybe the benefits of CAS over MT have been overestimated considering advances in medical therapy within10-year gap between CEA-versus-MT and CEA-versus-CAS studies.

키워드

Carotid artery stenosis; Carotid endarterectomy

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