Cerebral Hyperperfusion Syndrome And All Cause Mortality After Carotid Endarterectomy Or Carotid Angioplasty Stenting:A Meta-analysis

Objective: Cerebral hyperperfusion syndrome(CHS)is a rare complication after carotid revascularization including carotid endarterectomy(CEA)and carotid angioplasty stenting(CAS).It has been associated with significant mortality,although pooled data comparing these outcomes between open and endovascular treatment are lacking.Aim of this meta-analysis is to compare CHS risk and all cause mortality between carotid endarterectomy and carotid angioplasty with stenting.Methods: A systematic literature review was conducted,in order to identify eligible articles published prior to December 2018 through searching of Embase,The Cochrane Library,Medline,PubMed,VIP Chinese Scientific Journals database,CNKI and Wanfang data.Eligible studies compared CHS and/or all cause mortality between patients undergoing CEA and CAS.According to the types of included literatures,the corresponding quality evaluation was conducted,and the extracted data was summarized into a table.The statistical analyses in present study were carried out by Revman5.3.Outcome risks are presented as odds ratios(OR)and 95% confidence intervals(CI).Statistical calculation and analysis were performed with Revman5.3 and stata12.0.According to the results of heterogeneity test,the suitable model combination effect quantity was selected.The publication bias of this paper was evaluated by funnel chart drawing and Egger regression test.Results: Overall,A total of 8 articles were included in the meta-analysis.A total of 7990 patients under surgery included in this Meta-analysis of whom 3357 underwent CEA and 4633 underwent CAS.Analysis of the data suggested that CEA was associated with a higher risk for CHS compared to CAS(OR=1.35 [1.02,1.77] P=0.03).However,no difference was found regarding all cause mortality between the two methods(OR=0.69 [0.26,1.8] P=0.45)Conclusion: CEA seems to be associated with a higher risk for CHS compared to CAS.However,there seems to be no difference regarding all cause mortality between the two methods.