Karotis Stenozu Tedavisinde Karotis Arter Stentleme ve Karotis Endarterektomi Yöntemlerinin Kısa Dönem Sonuçları: Randomize Kontrollü Çalışmaların Güncel Bir Meta-Analizi

Abstract

Amaç: Karotis arter stentlemenin karotis endarterektomiye kıyasla daha iyi sonuçlar ürettiği düşünülmektedir. Bu hipotezi sınamak için, karotis arter stenozu geçiren hastalarda karotis arter stentleme ve karotis endarterektominin kısa süreli sonuçlarını değerlendirmek üzere yayınlanmış randomize kontrollü çalışmaların geniş kapsamlı değerlendirmesi yapıldı. Gereç ve Yöntemler: Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus ve Cochrane Central elektronik veri tabanları kullanılarak 1994'ten 31 Aralık 2022'ye kadar yayınlanmış olan denemelerin kapsamlı bir araştırması yapıldı. Yayınlardan temel sonlanım noktaları (herhangi bir inme türü, miyokard enfarktüsü ve tüm nedenlere bağlı ölüm) çıkarıldı. Sabit etkiler modeli iler etki büyüklüğü risk oranı (RO) ve %95 güven aralığı (GA) hesaplandı. Bulgular: Bu meta-analizine 15518 hastayı (8514 stentleme, 7004 endarterektomi) içeren 21 çalışma dahil edildi. Endarterektomi ile karşılaştırıldığında, stentleme, kısa süreli herhangi bir inme riskinde anlamlı derecede artma (RR=1,555; %95 GA: 1,307-1,851; p<0,001), ancak kısa süreli miyokard enfarktüsü riskinde ise azalma (RR=0,458; %95 GA: 0,319-0,660; p<0,001) ile ilişkiliydi. İki müdahale arasında tüm nedenlere bağlı ölüm açısından anlamlı bir fark yokken (RR=1,277; %95 GA: 0,835-1,952; p=0,259) endarterektomi lehine üstünlük eğilimi vardı. Sonuç: Endarterektominin herhangi bir inme türü açısından ve kısmen de tüm nedenlere bağlı ölüm açısından üstün olduğu, stentlemenin ise miyokard enfarktüsü açısından üstün olduğu görüldü. Ancak daha sağlam sonuçlar için gelecekte stentlemenin endarterektomiye karşı göreceli etkinliğini ele alan daha fazla çalışmalara ihtiyaç vardır.

Keywords

• Karotis endarterektomi
• meta-analizi
• randomize kontrollü çalışmalar
• kısa-dönem sonuçlar
• karotis arter stentleme

Short-Term Outcomes of Carotid Artery Stenting versus Carotid Endarterectomy in the Treatment of Carotid Stenosis: An Up-Dated Meta-Analysis of Randomized Controlled Trials

Abstract

Aim: Carotid artery stenting is thought to result in better outcomes when compared to carotid endarterectomy. To evaluate this hypothesis, a far-reaching of published randomized controlled trials were performed to evaluate the short-term outcomes of carotid artery stenting versus carotid endarterectomy for patients undergoing carotid artery stenosis. Material and Methods: A comprehensive search of trials published from 1994 until December 31, 2022, was performed using Science Direct, PubMed, Web of Science, Sage, Ebscohost, Scopus, and Cochrane Central electronic databases. Major endpoints (any stroke, myocardial infarction, and all-cause mortality) were extracted from the publications. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a fixed-effects model. Results: 21 trials involving 15518 patients (8514 with stenting, 7004 with endarterectomy) were included in the meta-analysis. Stenting was associated with a significantly increased risk of short-term any stroke (RR=1.555, 95% CI: 1.307-1.851, p<0.001) yet a significantly decreased risk of short-term myocardial infarction (RR=0.458, 95% CI: 0.319-0.660, p<0.001) when compared with endarterectomy. No significant difference was found in all-cause mortality between the two interventions (RR=1.277, 95% CI: 0.835-1.952, p=0.259), but with a trend toward superiority favoring endarterectomy. Conclusion: Endarterectomy was found to be superior in terms of any stroke and partially regarding all-cause mortality, whereas stenting was found to be superior in terms of myocardial infarction. Yet for robust results, further studies are needed to address the relative effectiveness of stenting versus endarterectomy in the future.

Keywords

• Carotid endarterectomy
• meta-analysis
• randomized controlled trial
• short-terms outcomes
• carotid artery stenting

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