■经颈动脉血运重建术(TCAR)是一种有症状的颈内动脉疾病的介入治疗。目前,由于证据有限,TCAR的使用存在争议。在这项研究中,与颈动脉内膜切除术(CEA)和颈动脉支架置入术(CAS)相比,我们评估了TCAR在有症状的颈内动脉疾病患者中的安全性和有效性.
■进行了系统评价,从2000年1月到2023年2月,包括使用TCAR治疗症状性颈内动脉疾病的研究。主要结果包括30天的卒中或短暂性脑缺血发作,心肌梗塞,和死亡率。次要结果包括颅神经损伤和大出血。计算每个结果的合并比值比(OR),以比较TCAR与CEA和CAS。此外,根据年龄和狭窄程度进行亚组分析.此外,我们通过排除血管质量主动登记人群进行了敏感性分析.
■共分析了7项研究,涉及24246名患者。在这个患者队列中,4771人接受了TCAR,12350接受了CEA,7125例患者接受CAS。与CAS相比,TCAR与中风或短暂性脑缺血发作的发生率相似(OR,0.77[95%CI,0.33-1.82])和心肌梗死(OR,1.29[95%CI,0.83-2.01]),但死亡率较低(OR,0.42[95%CI,0.22-0.81])。与CEA相比,TCAR与较高的卒中或短暂性脑缺血发作率相关(OR,1.26[95%CI,1.03-1.54]),但心肌梗死发生率相似(OR,0.9[95%CI,0.64-1.38])和死亡率(OR,1.35[95%CI,0.87-2.10])。
■尽管传统上认为CEA优于支架置入术治疗有症状的颈动脉狭窄,TCAR可能比CAS有一些优势。需要比较3种模式的前瞻性随机试验。
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: 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]).
UNASSIGNED: 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.