A Comparative Study On Results Of Patch Versus Eversion Carotid Endarterectomy: A Meta-analysis

Objective:To evaluate the safety and effectiveness of eversion(e CEA)and patch(p CEA)carotid endarterectomy on carotid artery stenosis.Methods:We searched literature publishing in journal in Pub Med(1970-2016),Cochrane(1970-2016)?Embase(1970-2016)?Ovid(1970-2016),CNKI(1970-2016.10),CBM(1970-2016.10).Study selection and assessment,data collection were undertaken by two reviewers independently according to the inclusion criteria and exclusion criteria.We use the Cochrane collaboration dedicated software Rev Man 5.2to analyze data.Results:A total of 10 studies were deemed eligible(1 512 e CEA and 1 787 p CEA procedures),three studies are randomized controlled trial and serven are nonrandomized controlled trial.Base on 3 213 patients underwent carotid artery stenosis including 3 299 cases.Mate analysis results are as follows.There were no significant differences in the characteristics of patients,including age,sex,smoking,hypertension,diabetes,coronary heart disease,hyperlipidemia,between p CEA and e CEA..ECEA was association with a shorter mean operation time(WMD-21.5195%CI:-26.17,-16.86)and less shunt usage(OR 0.11 95%CI:0.08,0.15P<0.00001).Furthermore,e CEA was associated with significant reduction perioperative stroke(OR 0.42 95%CI:0.23,0.76 P=0.004),medium-long term stroke(OR=0.20,95%CI:0.08~0.49,P =0.0005)and residual restenosis(OR 0.27P=0.008).However,no statistical significance in two groups of patients 30 day postoperative mortality(OR 0.66,95%CI:0.31,1.39 P =0.27).In addition,there were no statistically significant difference in the incidence of cranial nerve injury,reoperation,cardiovascular complications,TIA and neck hematoma after operation,between p CEA and e CEA.Conclusion:There were no significant differences in the characteristics of patients,including age,sex,smoking,hypertension,diabetes,coronary heart disease,hyperlipidemia,between p CEA and e CEA.Eversion CEA compared to patch CEA may be associated with a short operation time and short block time.There were no significant difference in postoperative the mortality rate of 30 days,cranial nerve injury,reoperation,cardiovascular complications,TIA and postoperative hematoma,between the two groups.ECEA appears to associated with better perioperative and medium-long term stroke than p CEA.ECEA may be more effective for medium-long prevention restenosis.