Carotid angioplasty with or without
stent placement (CAS) has been proposed as an alternative to
carotid endarterectomy (CEA) for the treatment of
carotid artery stenosis. We performed a systematic review and meta-analysis of randomized controlled trials to compare the safety and efficacy of
endovascular techniques with surgery for
carotid stenosis. We searched MEDLINE, PubMed and Cochrane databases to identify randomized controlled trials comparing CAS with CEA. Both random and fixed effects models were used to calculate the pooled odds ratios (OR) and their confidence intervals, with values lower than one indicating a benefit from the endovascular approach. Continuity correction was used for studies with zero events in one arm. We identified 11 trials randomizing a total of 3 258 patients; 1 623 to CEA and 1 635 to CAS. By random effects model, there was no significant difference between the treatments for any
stroke (OR, 1.28; 95% CI, 0.82-2.02), or death or any
stroke at 30-day (OR, 1.30; 95% CI, 0.92-1.84) and death or any
stroke at 6 months (OR, 1.34; 95% CI, 0.86-2.09) or 1 year (OR, 1.41; 95% CI, 0.24-8.27). However there was a significantly higher risk of 30-day death or any
stroke (OR, 1.33; 95% CI, 1.01-1.75) after CAS by fixed effects model. Endovascular treatment significantly reduced the risk of 30-day
cranial nerve injury (OR, 0.13; 95% CI, 0.04-0.44). In conclusion treating
carotid artery stenosis with CAS offers lower rates of
cranial nerve injury compared with CEA. CAS could not be proved to be as safe as CEA in treating
carotid artery stenosis. The results of ongoing randomized trials comparing CAS with CEA are easily awaited because they may provide sufficient evidence for a change in clinical practice.