颈动脉支架植入术与内膜剥脱术治疗颈动脉狭窄的疗效与安全性Meta分析

Carotid artery stenting or carotid endarterectomy for treatment of carotid stenosis: a Meta analysis of effectiveness and safety

目的应用Meta分析法综合评价颈动脉支架植入术(CAS)与颈动脉内膜剥脱术(CEA)治疗颈动脉狭窄的疗效与安全性。方法制定原始文献的检索策略,计算机检索国内外数据库中有关CAS及CEA治疗颈动脉狭窄的文献。按照纳入排除标准进行文献筛选,全文阅读所纳入文献,提取原始数据并评价文献质量,应用Rev Man5.3软件进行Meta分析。选择相对危险度(RR值)及双侧95%可信区间(CI)作为效应统计量。结果共纳入20篇研究9 189例患者,其中CAS组4 968例,CEA组4 221例。CAS组术后30 d发生脑卒中、死亡与脑卒中、非致残性脑卒中及术后1年发生重度再狭窄与完全闭塞事件的风险均高于CEA组,其RR值分别为1.60(95%CI 1.30~1.96),P<0.000 01;1.58(95%CI 1.31~1.91),P<0.000 01;1.89(95%CI 1.43~2.48),P<0.000 01;2.17(95%CI 1.44~3.28),P=0.000 2。CAS组术后30 d发生心肌梗死及中枢神经损伤事件的风险均低于CEA组,其RR值分别为0.46(95%CI 0.29~0.72),P=0.000 7;0.06(95%CI 0.03~0.13),P<0.000 01。两组术后30 d发生死亡及致残性脑卒中事件的风险差异无统计学意义,其RR值分别为1.29(95%CI 0.80~2.07),P=0.29;1.28(95%CI 0.91~1.80),P=0.16。结论两种手术方式各有优劣,对于颈动脉狭窄患者,应该充分探讨并了解每例患者的病情,根据患者的价值观和期望,医师的临床经验,科学的医学证据选择最适合患者的手术方案。

Objective Using the Meta analysis method, to evaluate the efficacy and safety of carotid stenting and carotid endarterectomy for the treatment of carotid stenosis.Methods The search strategy of original literatures were made, using the computer retrieval databases at home and abroad for randomized controlled trials related to CAS and CEA for the treatment of carotid stenosis. In accordance with the exclusion criteria to literature screening. To read the literatures, extract the raw data and evaluate the quality of literature. The enrolled literatures were analyzed with RevMan 5.3 Meta analysis software. To select the relative risk (RR) with its 95% confidential interval (CI) as the effect of statistics.Results There were 20 enrolled studies, including 9189 patients among whom, 4968 cases were in CAS group and 4221 in CEA group. Compared with the CEA group, the risk of stroke, death and stroke, non-disabling stroke within 30 days postoperatively and the risk of severe restenosis and occlusion within 1 year postoperatively were higher in the CAS group, the RR value was respectively 1.60 (95%CI 1.30-1.96),P<0.00001; 1.58 (95%CI 1.31-1.91),P<0.00001; 1.89 (95%CI 1.43-2.48),P<0.00001; 2.17 (95%CI 1.44-3.28),P=0.0002. Compared with the CEA group, the risk of myocardial infarction and cranial-nerve injury within 30 days postoperatively was lower in the CAS group, the RR value was respectively 0.46 (95%CI 0.29-0.72), P=0.0007; 0.06 (95%CI 0.03-0.13),P<0.00001. There were no significant differences in the risk of death and disabled stroke within 30 days postoperatively between the CAS and CEA group, the RR value was 1.29 (95%CI 0.80-2.07),P=0.29; 1.28 (95%CI 0.91-1.80),P=0.16 respectively.Conclusions Two kinds of surgical methods have their own advantages and disadvantages, we should fully explore and understand on each patient's condition, according to the patient's values and expectations, the doctor's clinical experience, the scientific medical evidence to select the most suitable surgical methods for carotid stenosis patients.