Journal article
Transcarotid Arterial Revascularization of Symptomatic Internal Carotid Artery Disease: A Systematic Review and Study-Level Meta-Analysis
Stroke (1970), Vol.55(4), pp.921-930
04/2024
DOI: 10.1161/STROKEAHA.123.044246
PMID: 38299350
Abstract
Transcarotid artery revascularization (TCAR) is an interventional therapy for symptomatic internal carotid artery disease. Currently, the utilization of TCAR is contentious due to limited evidence. In this study, we evaluate the safety and efficacy of TCAR in patients with symptomatic internal carotid artery disease compared with carotid endarterectomy (CEA) and carotid artery stenting (CAS).
A systematic review was conducted, spanning from January 2000 to February 2023, encompassing studies that used TCAR for the treatment of symptomatic internal carotid artery disease. The primary outcomes included a 30-day stroke or transient ischemic attack, myocardial infarction, and mortality. Secondary outcomes comprised cranial nerve injury and major bleeding. Pooled odds ratios (ORs) for each outcome were calculated to compare TCAR with CEA and CAS. Furthermore, subgroup analyses were performed based on age and degree of stenosis. In addition, a sensitivity analysis was conducted by excluding the vascular quality initiative registry population.
A total of 7 studies involving 24 246 patients were analyzed. Within this patient cohort, 4771 individuals underwent TCAR, 12 350 underwent CEA, and 7125 patients underwent CAS. Compared with CAS, TCAR was associated with a similar rate of stroke or transient ischemic attack (OR, 0.77 [95% CI, 0.33-1.82]) and myocardial infarction (OR, 1.29 [95% CI, 0.83-2.01]) but lower mortality (OR, 0.42 [95% CI, 0.22-0.81]). Compared with CEA, TCAR was associated with a higher rate of stroke or transient ischemic attack (OR, 1.26 [95% CI, 1.03-1.54]) but similar rates of myocardial infarction (OR, 0.9 [95% CI, 0.64-1.38]) and mortality (OR, 1.35 [95% CI, 0.87-2.10]).
Although CEA has traditionally been considered superior to stenting for symptomatic carotid stenosis, TCAR may have some advantages over CAS. Prospective randomized trials comparing the 3 modalities are needed.
Details
- Title: Subtitle
- Transcarotid Arterial Revascularization of Symptomatic Internal Carotid Artery Disease: A Systematic Review and Study-Level Meta-Analysis
- Creators
- Malik Ghannam - University of IowaMohammad AlMajali - University of IowaFarid Khasiyev - Department of Neurology (F.K.), Saint Louis University, MOMahmoud Dibas - University of IowaAbdullah Al Qudah - University of Pittsburgh Medical CenterFawaz AlMajali - Department of General Surgery (F.A.), Saint Louis University, MODana Ghazaleh - University of IowaAsghar Shah - Brown UniversityFayez H Fayad - Brown UniversityKareem Joudi - Brown UniversityBashar Zaidat - Brown UniversityChristopher A Childs - Hardin Library for the Health Sciences, The University of Iowa (C.A.C.)Bennett R Levy - George Institute for Global HealthYasmeen Abouainain - University of JordanDenise M D Özdemir-van Brunschot - Faculty of Medicine, University of Witten-Herdecke, Germany (D.M.D.O.-v.B.)Liqi Shu - Brown UniversityEric D Goldstein - Brown UniversityAmmad A Baig - Kaleida HealthHannah Roeder - Department of Neurology, University of Iowa Carver College of Medicine (M.G., M.A., M.D., D.G., H.R., E.C.L.)Nils Henninger - Department of Neurology, University of Massachusetts Chan Medical School, Worcester (N.H.)Adam de Havenon - University of New HavenElad I Levy - Kaleida HealthCharles Matouk - University of New HavenColin P Derdeyn - Department of Radiology (C.P.D.) and Department of Neurosurgery (E.C.L.), University of Iowa College of MedicineEnrique C Leira - Department of Epidemiology, University of Iowa College of Public Health (E.C.L.)Seemant Chaturvedi - University of Maryland, BaltimoreShadi Yaghi - Brown University
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.55(4), pp.921-930
- DOI
- 10.1161/STROKEAHA.123.044246
- PMID
- 38299350
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Electronic publication date
- 02/01/2024
- Date published
- 04/2024
- Academic Unit
- Neurology; Epidemiology; Iowa Neuroscience Institute; Neurosurgery; Hardin Library
- Record Identifier
- 9984555556502771
Metrics
7 Record Views