Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis*

被引：2

作者：

Marsman, Martijn S. ^{[1
,2
,12
]}

Wetterslev, Jarn ^{[3
]}

Vriens, Patrick W. H. E. ^{[4
,5
]}

Bleys, Ronald L. A. W. ^{[6
]}

Jahrome, Abdelkarime Kh. ^{[7
]}

Moll, Frans L. ^{[8
]}

Keus, Frederik ^{[9
]}

Reijnen, Michel M. P. J. ^{[1
,10
]}

Koning, Giel G. ^{[11
]}

机构：

[1] Rijnstate Hosp, Dept Vasc Surg, Arnhem, Netherlands

[2] Radboud Univ Nijmegen, Dept Surg, Med Ctr, Nijmegen, Netherlands

[3] Tuborg Sundpark, Private Off, Hellerup, Denmark

[4] Elisabeth TweeSteden Hosp, Dept Vasc Surg, Tilburg, Netherlands

[5] Tilburg Univ, Dept Med & Clin Psychol, Tilburg, Netherlands

[6] Univ Med Ctr Utrecht, Dept Anat, Utrecht, Netherlands

[7] Med Ctr Leeuwarden, Dept Vasc Surg, HFG, Leeuwarden, Netherlands

[8] Univ Med Ctr Utrecht, Dept Vasc Surg, Utrecht, Netherlands

[9] Univ Groningen, Univ Med Ctr Groningen, Dept Crit Care, Groningen, Netherlands

[10] Univ Twente, TechMed Ctr, Multimodal Med Imaging Grp, Enschede, Netherlands

[11] Euregio Hosp, Dept Vasc Surg, Nordhorn, Germany

[12] Radboud Univ Nijmegen, Med Ctr, Geert Grooteplein Zuid 10, NL-6525 GA Nijmegen, Netherlands

来源：

SURGERY OPEN SCIENCE | 2023年 / 13卷

关键词：

Carotid endarterectomy; Systematic review; Eversion technique; Patch; Stenosis; Blood pressure; DESIGN CHARACTERISTICS; SYMPTOMATIC PATIENTS; CEREBRAL-ISCHEMIA; STENOSIS; GRADE; RISK; OCCLUSION; QUALITY; CLOSURE;

D O I：

10.1016/j.sopen.2023.05.003

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Introduction: The use of an 'eversion' technique is not unequivocally proven to be superior to carotid endarterectomy with patch angioplasty. An up-to-date systematic review is needed for evaluation of benefits and harms of these two techniques. Methods: RCTs comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic and significant (& GE;50 %) stenosis of the internal carotid artery were enrolled. Primary outcomes were all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes included 30-day stroke and mortality rate, (a) symptomatic arterial occlusion or restenosis, and adverse events not critical for decision making. Results: Four RCTs were included with 1272 surgical procedures for carotid stenosis; eversion technique n = 643 and carotid endarterectomy with patch closure n = 629. Meta-analysis comparing both techniques showed, with a very low certainty of evidence, that eversion technique might decrease the number of patients with serious adverse events (RR 0.47; 95% CI 0.34 to 0.64; p & LE; 0.01). However, no difference was found on the other outcomes. TSA demonstrated that the required information sizes were far from being reached for these patient-important outcomes. All patient-relevant outcomes were at low certainty of evidence according to GRADE. Conclusions: This systematic review showed no conclusive evidence of any difference between eversion technique and carotid endarterectomy with patch angioplasty in carotid surgery. These conclusions are based on data obtained in trials with very low certainty according to GRADE and should therefore be interpreted cautiously. Until conclusive evidence is obtained, the standard of care according to ESVS guidelines should not be abandoned. & COPY; 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：99 / 110

页数：12

共 58 条

[1] Medical (Nonsurgical) Intervention Alone Is Now Best for Prevention of Stroke Associated With Asymptomatic Severe Carotid Stenosis Results of a Systematic Review and Analysis [J].