内膜斑块剥脱术与支架置入术治疗颈动脉狭窄的Meta分析

Endarterectomy versus stenting for carotid artery stenosis: a meta-analysis of randomized controlled clinical trials

目的 探讨颈动脉内膜斑块剥脱术（CEA）与颈动脉支架置入术（CAS）治疗颈动脉狭窄的疗效。方法 计算机检索Pubmed、Embase数据库,收集CEA与CAS治疗颈动脉狭窄的随机对照研究,应用Stata软件进行统计分析。结果 共纳入12项研究,共7 401例患者。Meta分析结果显示：术后30 d,CAS组卒中和死亡联合事件发生率（OR=1.51,95%CI为1.23~1.84;P〈0.001）、任意卒中事件发生率（OR=1.47,95%CI为1.18~1.83;P〈0.001）均明显高于CEA组;而心肌梗死发生率（OR=0.46,95%CI为0.28~0.75;P=0.002）、颅神经损伤发生率（OR=0.08,95%CI为0.04~0.14;P〈0.001）均明显低于CEA组。两组致残性卒中和死亡联合事件发生率（OR=1.28,95%CI为0.93~1.77;P=0.13）、病死率（OR=1.52,95%CI为0.96~2.41;P=0.07）、致残性卒中发生率（OR=1.16,95%CI为0.79~1.71;P=0.46）无明显差异。结论 CAS治疗颈动脉狭窄短期安全性和有效性与CEA类似。

Objective To evaluate the efficacy of carotid artery stenting （CAS） and carotid enadrterectomy （CEA） for carotid stenoses. Method The randomized clinical trials of CAS versus CEA for carotid stenoses were searched from the databases including Medline and Embase. The meta-analysis of the searched data was performed by Stata software. Results A total of 12 trials involving 7 401 patients were finally included. Meta-analysis showed that the occurent rates of stroke （OR=1.47, 95% CI 1.18 to 1.83, P〈0.001） and stroke and death （OR=l.51, 95% CI 1.23 to 1.84, P〈0.001） 30 days after the treatment were significantly higher in CAS group than those in CEA group. The occurent rates of myocardial infarctions （OR 0.46, 95% CI 0.28 to 0.75, P=0.002） and cranial nerve injury （OR=0.08, 95% CI 0.04 to 0.14, P〈0.001） were significantly lower in CAS group than those in CEA group. There were no significant differences in the rate of death （OR=1.52, 95% CI 0.96 to 2.41, P=0.07）, disabling stroke （OR--1.16, 95% C1 0.79 to 1.71, P=0.46）, disabling stroke or death （OR=1.28, 95% CI 0.93 to 1.77, P=0.13） between both the groups. Conclusion The safety of CAS and its short-term effect on carotid stenosis are similar to CEA. [Key words] Carotid stenosis; Endarterectomy; Carotid stenting; Meta-analysis