颈动脉血管成形术和颈动脉内膜切除术治疗颈动脉狭窄近期疗效的Meta分析

目的评价颈动脉血管成形术和颈动脉内膜切除术治疗颈动脉狭窄的近期临床疗效和安全性。方法电子检索中国学术期刊网全文数据库(1996—2006年)、MEDLINE(1996—2006年)和Cochrane图书馆(2006年12月前已发表的文献和已注册但未发表的临床试验),并与研究者取得联系获得更多的相关研究资料。纳入比较颈动脉血管成形术和内膜切除术治疗颈动脉狭窄的随机对照试验,比较两种治疗方法术后30d内卒中发生率和卒中与死亡的联合发生率。以卒中发生率作为疗效评价指标,以卒中和死亡的联合发生率作为安全性评价指标。2名评价员独立检索和提取资料,对纳入试验的方法学质量进行评价,数据采用RevMan4.2.10版软件进行统计分析。结果在术后30d内的卒中发生率方面,共纳入7项临床试验的2747例患者,其中颈动脉血管成形术组1381例,颈动脉内膜切除术组1366例。在术后30d的卒中和死亡的联合发生率方面,纳入8项临床试验,共2966例患者,其中颈动脉血管成形术组1488例,颈动脉内膜切除术组1478例。Meta分析结果显示,在术后30d内的卒中发生率方面,颈动脉血管成形术略高于颈动脉内膜切除术(OR:1.44;95%CI:1.05~1.97,Z=2.28,P=0.02);在术后30d内卒中和死亡的联合发生率方面,颈动脉血管成形术与颈动脉内膜切除术间差异无统计学意义(OR:1.50;95%CI:0.89~2.52,Z=1.51,P=0.13)。结论现有临床研究资料显示,在目前的技术条件下,颈动脉血管成形术在治疗颈动脉狭窄的近期疗效方面未显示优于内膜切除术;而在治疗的安全性方面,两者间差异无统计学意义。

Short-term efficacy of carotid angioplasty and stenting versus carotid endarterectomy for the treatment of asymptomatic carotid stenosis: a meta-analysis

Objective To evaluate the short-term clinical efficacy and safety of carotid angioplasty and stenting (CAS) versus carotid endarterectomy (CEA) for the treatment of carotid stenosis. Methods We searched electronic database including CNKI (1996-2006), MEDLINE (1996-2006) and Cochrane Library(before Dec.2006), and more related research data were obtained by contacting corresponding researchers. The randomized controlled trials comparing CAS and CEA for the treatment of carotid stenosis were included; the stroke rate, and the combined death and stroke rate were compared within 30 days after the two procedures. The stroke rate was used as an outcome measure, and the combined death and stroke rate was used as an outcome measure of safety. Data were retrieved and extracted by two reviewers independently, and were cross-checked. Statistical analysis was performed by using RevMan 4.2.10. Results Seven trials including 2747 patients were included in the stroke rate within 30 days after the procedures, among them 1381 patients were in the CAS group and 1366 patients were in the CEA group. Eight trials including 2966 patients were included in the stroke and death rate within 30 days after the procedures, among them 1488 patients were in the CAS group and 1478 patients were in the CEA group. The results of meta-analysis idicated that the stroke rate of CAS was slightly higher than that of CEA within 30 days after the procedures (OR: 1.44, 95% CI, 1.05-1.97,Z=2.28,P=0.02); there was no significant difference between CAS and CEA in the combined stroke and death rate within 30 days after the procedures (OR 1.50, 95% CI, 0.89-2.52,Z=1.51,P=0.13). Conclusions The available clinical data indicate that short-term efficacy of CAS in the treatment of carotid stenosis is not superior to CEA in the context of current technique; and there is no significant difference between CAS and CEA in the safety of the treatment.