颈动脉内膜剥脱术与颈动脉支架置入术治疗颈动脉狭窄疗效与安全性的Meta分析

Effectiveness and Safety of Carotid Endarterectomy Versus Carotid Artery Stenting in Treatment of Carotid Artery Stenosis: A Meta-Analysis

目的对颈动脉内膜剥脱术（CEA）和颈动脉支架置入术（CAS）治疗颈动脉狭窄的疗效和安全性进行Meta分析。方法计算机检索Pub Med、EMBASE、Cochrane Library、Web of science、万方及CNKI数据库中1990年1月至2015年7月期间发表的关于CEA和CAS治疗颈动脉狭窄的随机对照试验,收集相关数据,采用Rev Man 5.1软件进行Meta分析。结果最终纳入15个随机对照试验,共计9 828例颈动脉狭窄患者。Meta分析结果显示：与CAS组比较,CEA组术后30 d之内的脑卒中发生率或死亡率（OR=0.63,95%CI：0.51～0.77,P〈0.05）和术后任何时点的脑卒中发生率或死亡率、或术后30 d之后同侧脑梗塞的发生率（OR=0.61,95%CI：0.48～0.76,P〈0.05）均较低;但术后30 d之内的心肌梗塞发生率（OR=1.81,95%CI：1.14～2.87,P=0.01）和中枢神经损伤发生率（OR=18.28,95%CI：7.99～41.82,P〈0.05）均较高。结论虽然CAS组术后30 d之内的中枢神经损伤和心肌梗塞的发生率比CEA组低,但是,CEA组术后30 d之内的脑卒中发生率或死亡率和术后任何时点的脑卒中发生率或死亡率、或术后30 d之后同侧脑梗塞的发生率均较低,因此从术后安全性和术后长期疗效来说,CEA仍有优势,仍然是治疗颈动脉狭窄的金标准。

Objective To update available evidence on safety and efficacy of carotid endarterectomy（CEA） versus carotid artery stenting（CAS） in treatment of carotid artery stenosis by a Meta-analysis of randomized controlled trials（RCTs）.Methods A comprehensive search was performed of Pub Med, EMBASE, Cochrane Library, Web of science, Wan Fang, and CNKI databases（from January 1990 to July 2015）, to collect articles and past systematic reviews, and then abstraced lists of recent scientific conferences which were related with safety and efficacy of CEA versus CAS in treatment of carotid artery stenosis. At last, Meta analysis was performed by Rev Man 5.1 software. Results Fifteen RCTs enrolling 9 828 patients were included in the Meta-analysis. Compared with CAS, CEA was associated with a significantly lower incidences of any stroke or death within 30 days after surgery（OR=0.63, 95% CI： 0.51-0.77, P〈0.05） and any stroke or death during follow-up,or ipsilateral stroke after 30 days of operation（OR=0.61, 95% CI： 0.48-0.76, P〈0.05）, but associated with a significantly greater incidences of myocardial infarction（OR=1.81, 95% CI： 1.14-2.87, P=0.01） and cranial neuropathy（OR=18.28, 95%CI： 7.99-41.82, P〈0.05） within 30 days after surgery. Conclusions In comparison with CAS, CEA is associated with a lower incidences of stroke or death and a greater incidence of myocardial infarction and cranial neuropathy within 30 days after surgery, and was associated with a significantly lower incidence of any stroke or death during follow-up, or ipsilateral stroke after 30 days of operation. So the results of Meta-analysis support continued use of CEA as the standard method in treatment of carotid artery stenosis.