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2018 ; 8
(1
): 4458
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Systematic review and network meta-analysis of treatment strategies for
asymptomatic carotid disease
#MMPMID29535395
Barkat M
; Roy I
; Antoniou SA
; Torella F
; Antoniou GA
Sci Rep
2018[Mar]; 8
(1
): 4458
PMID29535395
show ga
We aim to perform a systematic review and meta-analysis to investigate outcomes
of treatment strategies for asymptomatic carotid disease. We searched electronic
bibliographic sources (MEDLINE, EMBASE, CINAHL and CENTRAL) to identify
randomised controlled trials (RCT) reporting comparative outcomes of carotid
endarterectomy (CEA), carotid stenting (CAS) and best medical therapy (BMT) in
asymptomatic carotid disease. We performed pairwise meta-analysis applying random
or fixed-effects models and reported the results as the odds ratio (OR) or risk
difference (RD) and 95% confidence interval (CI). We also performed a network
meta-analysis and obtained a hierarchy of the competing interventions using
rankograms and the surface under the cumulative ranking curve and mean ranks.
Stroke and death within 30 days and during follow up were the primary outcome
endpoints. Eleven RCTs were identified reporting a total of 8,954 patients.
Compared to BMT, CEA reduces the odds of long-term mortality (OR 0.70, 95% CI
0.43, 1.12) and ipsilateral stroke (OR 0.59 95% CI 0.50, 0.71). Network
meta-analyses league table demonstrated that BMT is superior to CEA and CAS in
terms of perioperative stroke risk and mortality. CEA is the preferred method to
reduce the long-term risk of ipsilateral stroke and mortality for patients with
asymptomatic carotid disease.