The data are difficult to interpret because the trials are heterogeneous (different patients, endovascular procedures, and duration of follow up) and five trials were stopped early, perhaps leading to an over-estimate of the risks of endovascular treatment.
The pattern of effects on different outcomes does not support a change in clinical practice away from recommending carotid endarterectomy as the treatment of choice for suitable carotid artery stenosis.
This review, which included 12 trials involving 3227 participants, showed that surgery might be better than endovascular treatment in preventing early stroke or death, but there were fewer immediate neurological complications with endovascular treatment than with surgery.
During follow-up, the risk of stroke or death was similar after endarterectomy compared to endovascular treatment. Treated arteries may be more likely to narrow down after endovascular treatment than after carotid endarterectomy.
A search was made for randomized clinical trials comparing CAS and CEA
A meta-analysis was performed using a random effects model because significant heterogeneity was observed.
Outcomes compared included 1-month composite rates of stroke or death, all strokes, disabling strokes, myocardial infarction, cranial nerve injury, and major bleeding and 1-year rates of both minor and major ipsilateral strokes.
IDENTIFICATION AND CRITERIA FOR INCLUSION OF TRIALS IN THE REVIEW
The trials were identified by an electronic database search (MEDLINE, PubMed, and Cochrane databases from 1990 to 2003). Electronic search terms included: carotid stenosis, carotid endarterectomy, carotid stent, and carotid angioplasty.
These terms were cross-referenced with prospective study, controlled trial, and randomization.
METHODS OF THE REVIEW AND QUALITY ASSESSMENT OF TRIALS
The scale grades the quality of three items describing randomization (0–2 points), double blinding (0–2 points), and dropouts and withdrawals (0–1 point). A higher score indicates better reporting.