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Carotid Angioplasty Stenting versus Endarterectomy versus Best Medical Treatment – What is the best strategy for the treatment of Carotid Stenosis?
Session:
Comunicações Orais (Sessão 21) - Intervenção Cardíaca Coronária e Estrutural 3 - Vários Tópicos
Speaker:
Rafaela Fernandes
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rafaela Fernandes; Joana Delgado Silva; Joana Moura Ferreira; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Background: </span></strong><span style="font-family:Arial,sans-serif">Carotid stenosis causes 15% of strokes, which represent 10,8% of deaths in Portugal. Carotid angioplasty stenting (CAS), endarterectomy (CEA) and best medical treatment (BMT) are important in preventing <em>major</em> cardiovascular (CV) events. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Methods: </span></strong><span style="font-family:Arial,sans-serif">We conducted a systematic review and metanalysis, with randomized controlled trials (RCT), to compare CAS with CEA and BMT regarding the short and long-term major periprocedural and follow-up CV events (stroke, myocardial infarction, and death) in symptomatic and asymptomatic carotid stenosis. We searched for RCT published from 2008 to 2021 in </span><span style="font-family:Arial,sans-serif">databases such as <em>Pubmed/MEDLINE, B-On, Embase, Clinical Trials from U.S. National Library of medicine and International Clinical Trials Registry Platform</em>, between July of 2018 and January of 2019, and in October of 2021. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Results: </span></strong><span style="font-family:Arial,sans-serif">Nine RCT were included, with a total of 9162 participants for CAS <em>versus</em> (vs) CEA, and 513 participants for CAS vs TMO. Compared with CEA, CAS is associated with periprocedural stroke and death in symptomatic patients (HR=1.65, CI 95% 1.29-2.11, <em>p</em>=0.05, I<sup>2</sup>=62%), due to higher stroke events than deaths. That association does not occur in asymptomatic patients in which CAS is not associated with periprocedural stroke or death (CAS=8.55%, CEA=7.05%, <em>p</em>=0.09). During follow-up there were no significant differences between CAS and CEA in symptomatic patients regarding stroke (HR=1.51, CI 95% 1.23-1.84, <em>p</em>=0.57, I<sup>2</sup>=0%) and death (HR=1.10, CI 95% 0.93-1.30, <em>p</em>=0.69, I<sup>2</sup>=0%). Periprocedural MI incidence is higher in CEA (CAS=1.1%; CEA=2.3%; <em>p</em>=0.03), without influence of symptomatic status. CAS is not inferior to CEA, in both symptomatic and asymptomatic patients with high surgery risk, as for periprocedural and one year CV <em>major</em> events (CAS=12.2%, CEA=20.1%, absolute difference=-7.9, CI 95% -16.4-0.7, <em>p</em>=0.004). BMT had no significant findings vs CAS in asymptomatic patients (HR=3.5, CI 95% 0.42-29.11, <em>p</em>=0.246). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Conclusion: </span></strong><span style="font-family:Arial,sans-serif">CAS is not inferior to CEA as for the periprocedural and one-year <em>major</em> CV events in patients with normal surgery risk. However, there is a higher risk of periprocedural stroke in CAS for symptomatic patients, and of periprocedural MI in CEA with no influence of symptomatic status. CAS seams to prevent middle and long-term ipsilateral stroke in symptomatic patients. BMT has yet to prove not to be inferior to CAS in asymptomatic patients. </span></span></span></span></p>
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