Eversion Versus Standard Carotid Endarterectomy In Management Of Carotid Stenosis: A Meta-analysis

Objective: To evaluate eversion carotid endarterectomy(ECEA) and standard carotid endarterectomy(SCEA) in the treatment of carotid stenosisMethods: Relevant randomized controlled trials(RCTs) were searched in Pub Med,Embase,Cochrane Library,China Knowledge Resource Integrated Database(CNKI),China Biology Medicine Database(CBM),and Wan Fang Database from 1 January,1992 to 1 July,2015. What’s more we also searched the datum through search engine. We analyzed data by the Cochrane Collaboration’s Rev Man 5.3,GRADEpro 3.6.1,and TSA Viewer Version 0.9 software.Results: The original search identified 762 articles in electronic database. We excluded 696 studies after review of the title and abstract. 66 articles were assessed their accordance with the inclusion criteria. Finally,7article were considered eligible for inclusion in the meta-analysis. A total of 2666 patients underwent 2790 CEA procedures(1406ECEA; 1384SCEA). Compered with SCEA,ECEA significantly decreased the incidence of late carotid restenosis or occlusion [RR=0.44, 95%CI 0.30-0.66,P<0.0001 ]. In TSA,the curve crossed the traditional boundary(P=0.05) but did not cross the interim monitoring boundaries,which might indicated further randomized controlled trials is needed. ECEA was association with a shorter internal carotid artery clamp time [MD=-6.74, 95%CI-12.21--1.28, P=0.02 ],but the test for heterogeneity was significant(I2=97%,P<0.00001). This result should be interpreted with caution. Moreover,ECEA was associated with remarkable reduction in perioperative stroke [RR=0.53, 95%CI 0.32-0.88,P=0.01 ], the use of shunt [RR=0.66, 95%CI 0.51- 0.85,P=0.01 ]. NO significant difference was observed between ECEA and SCEA in the risk for residual carotid artery stenosis or early carotid artery occlusion,perioperative death,cranial nerve injury,myocardial infarction and neck hematoma.Conclusion: ECEA is equivalent or even superior to PCEA. However, the results should be interpreted cautiously due to the heterogeneity among the studies. Thus, we should cautiously interpret the finding.