颈动脉支架置入术与内膜切除术治疗颈动脉狭窄的远期转归比较：随机对照试验的汇总分析

Long-term outcomes of carotid artery stenting versus endarterectomy for carotid stenosis： A meta-analysis of randomized controlled trials

目的通过汇总分析评价颈动脉内膜切除术（carotid endarterectomy, CEA）与颈动脉支架置入术（carotid artery stenting, CAS）治疗颈动脉狭窄的远期转归。方法检索PubMed、EMBASE和Cochrane数据库，纳入在颈动脉狭窄患者中比较CEA与CAS治疗的随机对照试验，提取研究基本特征以及远期转归，包括卒中或死亡联合终点、任何卒中、任何死亡等数据，应用Stata软件进行统计分析。结果共纳入7项随机对照试验和8 210例患者，随访时间中位数为2～7.4年。纳入研究的质量整体较高，产生偏倚的风险较低。汇总分析显示，CAS组卒中或死亡联合终点[风险比（hazard risk, HR） 1.21，95% CI 1.04～1.39]、任何卒中（HR 1.32，95% CI 1.15～1.51）和同侧卒中（HR 1.26，95% CI 1.02～1.55）风险显著高于CEA组；CAS组死亡（HR 1.06，95% CI 0.95～1.18）、致残性卒中（HR 1.23，95% CI 0.95～1.60）、非同侧卒中（HR 1.12，95% CI 0.81～1.55）和再狭窄（HR 1.18，95% CI 0.91～1.52）风险均与CEA组无显著性差异，但。结论CAS在远期死亡、致残性卒中、非同侧卒中和再狭窄风险方面与CEA相近，但CAS的远期卒中或死亡联合终点、任何卒中和同侧卒中风险显著更高。这些结果提示，CEA仍是颈动脉狭窄的治疗选择。

Objective To evaluate the long-term outcomes of carotid endarterectomy versus carotid artery stenting for carotid stenosis. Methods PubMed, EMBASE, and the Cochrane databases were retrieved. The randomized controlled trials of comparing CEA with CAS in patients with carotid artery stenosis were enrolled. The data such as the research basic characteristics and the long-term outcomes including stroke or death combined endpoints, any stroke or any death were extracted. The Stata software was used to conduct statistical analysis. Resutls A total of 7 randomized controlled trials and 8 210 patients were included. The median follow-up time was 2-7.4 years. The overall quality of the included studies was high and the risk of bias was low. The meta-analysis showed that the risks of the combined endpoint of stroke or death （hazard risk [ HR ] 1.21,95 % confatence interval [ CI] 1.04-1.39）, any stroke （HR 1.32, 95 % CI 1.15-1.5 t） and ipsilateral stroke （HR 1.26, 95% CI 1.02-1.55） in the CAS group were significantly higher than those in the CEA group; the risks of death （HR 1.06, 95% CI 0. 95-1.18）, disabling stroke （HR 1.23, 95% CI 0. 95- 1.60）, non-ipsilateral stroke （HR 1.12,95% CI 0. 81-1.55） and restenosis （HR 1.18,95% CI 0. 91-1. 52） were not significantly different between between the CAS group and the CEA group. Conclusions CAS and CEA are associated with similar risks of long-term death, disabling stroke, non-ipsilateral stroke and restenosis. The risks of long-term combined endpoint of stroke or death, any stroke and ipsilateral stroke significantly higher with CAS. These results suggest that CEA remains the treatment of choice for carotid stenosis.