Summary of evidence on early carotid intervention for recently symptomatic stenosis based on meta-analysis of current risks

Paola De Rango, Martin M. Brown, Seemant Chaturvedi, Virginia J. Howard, Tudor Jovin, Michael V. Mazya, Maurizio Paciaroni, Alessandra Manzone, Luca Farchioni, Valeria Caso

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Background and Purpose - This study aimed to assess the evidence on the periprocedural (<30 days) risks of carotid intervention in relation to timing of procedure in patients with recently symptomatic carotid stenosis. Methods - A systematic literature review of studies published in the past 8 years reporting periprocedural stroke/death after carotid endarterectomy (CEA) and carotid stenting (CAS) related to the time between qualifying neurological symptoms and intervention was performed. Pooled estimates of periprocedural risk for patients treated within 0 to 48 hours, 0 to 7 days, and 0 to 15 days were derived with proportional meta-analyses and reported separately for patients with stroke and transient ischemic attack as index events. Results - Of 47 studies included, 35 were on CEA, 7 on CAS, and 5 included both procedures. The pooled risk of periprocedural stroke was 3.4% (95% confidence interval [CI], 2.6-4.3) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS performed <15 days; stroke/death rates were 3.8% and 6.9% after CEA and CAS, respectively. Pooled periprocedural stroke risk was 3.3% (95% CI, 2.1-4.6) after CEA and 4.8% (95% CI, 2.5-7.8) after CAS when performed within 0 to 7 days. In hyperacute surgery (<48 hours), periprocedural stroke risk after CEA was 5.3% (95% CI, 2.8-8.4) but with relevant risk differences among patients treated after transient ischemic attack (2.7%; 95% CI, 0.5-6.9) or stroke (8.0%; 95% CI, 4.6-12.2) as index. Conclusions - CEA within 15 days from stroke/transient ischemic attack can be performed with periprocedural stroke risk <3.5%. CAS within the same period may carry a stroke risk of 4.8%. Similar periprocedural risks occur after CEA and CAS performed earlier, within 0 to 7 days. Carotid revascularization can be safely performed within the first week (0-7 days) after symptom onset.

Original languageEnglish (US)
Pages (from-to)3423-3436
Number of pages14
JournalStroke
Volume46
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • carotid stenosis
  • endarterectomy
  • meta-analysis
  • stents
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    De Rango, P., Brown, M. M., Chaturvedi, S., Howard, V. J., Jovin, T., Mazya, M. V., Paciaroni, M., Manzone, A., Farchioni, L., & Caso, V. (2015). Summary of evidence on early carotid intervention for recently symptomatic stenosis based on meta-analysis of current risks. Stroke, 46(12), 3423-3436. https://doi.org/10.1161/STROKEAHA.115.010764