颈动脉支架与内膜切除术治疗颈动脉狭窄疗效和安全性的Meta分析

Safety and efficacy of carotid artery stenting versus carotid endarterectomy for the treatment of carotid stenosis： a meta-analysis

目的 系统评价颈动脉支架（carotid artery stenting，CAS）和颈动脉内膜切除术（carotid endarterectomy，CEA）治疗颈动脉狭窄的安全性和疗效。方法 计算机检索PubMed、EMbase、Cochrane图书馆临床对照试验资料库、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）以及万方医学数据库，并辅以手工检索，收集CAS和CEA治疗颈动脉狭窄的随机对照试验，采用Cochrane协作网提供的RevMan5．0．24软件进行Meta分析。结果 共纳入12个研究，6903例患者，其中（、AS纽3460例，CEA组3443例。cAS组术后30d脑卒中或死亡联合发生风险（RR＝1．64，95％CI：1．33～2．03，P〈0．00001）以及脑卒中风险（RR＝1．70，95％CI：1．34～2．14，P〈0．00001）高于CEA组；CEA组术后30d心肌梗死风险（RR＝0．62，95％CI：0．39～0．97，P＝0．04）和颅神经损伤风险（RR＝0．07，95％CI：0．03～0．16，P〈20．00001）高于CAS组；两组术后30d死亡风险（RR＝1．33，95％CI：0．78～2．28，P＝0．29）、致残性脑卒中风险（RR＝1．27，95％CI：0．82～1．96，P＝0．29）和术后1年脑卒中或死亡联合发生风险（RR＝0．96，95％C：0．63～1．46，P＝0．84）差异无统计学意义。结论从安全性方面考虑，对于一般手术风险的颈动脉狭窄患者，CEA仍是治疗颈动脉狭窄的首选治疗手段。具有手术高危因素或不适合手术的患者，CAS治疗更具有优势。

Objective To compare the safety and efficacy of carotid artery stenting （CAS） and carotid endarterectomy（CEA） for the treatment of carotid stenosis. Methods The electronic databases （PubMed, EMbase, Cochrane Central Register of Controlled Trials, CNKI, VIP and Wanfang） were searched in order to retrieve randomized controlled trials （RCTs） about comparing CAS and CEA for the treatment of carotid stenosis. Cochrane collaboration＇s RevMan 5.0.24 were used for analyzing data. Results Twelve RCTs totalling 6903 patients （3460 patients were randomized to CAS and 3443 randomized to CEA） with symptomatic or asymptomatic stenosis were included in the meta-analysis. There were significantly higher 30-day relative risks after CAS than after CEA for death or any stroke [RR=1.64, 95%CI （1.33-2.03）, P〈0.000013 and for stroke [RR=1.70, 95%CI （1.34-2. 14）, P〈0.00001]. The relative risks of myocardial infarction [RR= 0.62, 95%CI （0.39-0.97）, P=0.04] and cranial neuropathy [RR=0.07, 95%CI （0.03-0.16）, P〈0. 00001] was significantly less after CAS than after CEA. The relative risks of death [RR = 1.27, 95%Cl （0.82-1.96）, P=0.293] or disabling stroke within 30 days [RR=l.33, 95% CI （0.78- 2.28）, P=0. 29 and any stroke or death at 1 year after the procedures [RR=0.96, 95%CI （0.63-1.46）, P=0. 84] did not differ significantly between CAS and CEA operation. Conclusions CEA remains the first choice for treatment of carotid stenosis for patients with low surgery risk. For patients with high surgery risk and unsuitable for surgery, CAS has more advantages. It is reasonable to view CAS and CEA as complementary rather than competing modes of therapy.