alexa A systematic review and meta-analysis of randomized trials of carotid endarterectomy vs stenting.
Cardiology

Cardiology

Journal of Clinical & Experimental Cardiology

Author(s): Murad MH, Shahrour A, Shah ND, Montori VM, Ricotta JJ

Abstract Share this page

Abstract OBJECTIVE: The purpose of this systematic review and meta-analysis was to synthesize the available evidence derived from randomized controlled trials (RCTs) regarding the relative efficacy and safety of endarterectomy vs stenting in patients with carotid artery disease. METHODS: We searched MEDLINE, EMBASE, Current Contents, and Cochrane CENTRAL through July 2010 to update previous systematic reviews. Two reviewers determined trial eligibility and extracted descriptive, methodologic, and outcome data (death, nonfatal stroke, and nonfatal myocardial infarction). Random-effects meta-analysis was used to pool relative risks and the I(2) statistic was used to assess heterogeneity. RESULTS: Thirteen RCTs proved eligible enrolling 7484 patients, of which 80\% had symptomatic disease. Methodological quality was moderate to high, with better quality among RCTs published after 2008. Compared with carotid endarterectomy, stenting was associated with increased risk of any stroke (relative risk [RR], 1.45; 95\% confidence interval [CI], 1.06-1.99; I(2) = 40\%), decreased risk of periprocedural myocardial infarction (MI; RR, 0.43; 95\% CI, 0.26- 0.71; I(2) = 0\%), and nonsignificant increase in mortality (RR, 1.40; 95\% CI, 0.85-2.33; I(2) = 5\%). When analysis was restricted to the two most recent trials with the better methodology and more contemporary technique, we found stenting to be associated with a significant increase in the risk of any stroke (RR, 1.82; 95\% CI, 1.35-2.45) and mortality (RR, 2.53; 95\% CI, 1.27-5.08) and a nonsignificant reduction of the risk of MI (RR, 0.39; 95\% CI, 0.12-1.23). For every 1000 patients opting for stenting rather than endarterectomy, 19 more patients would have strokes and 10 fewer would have MIs. Outcome data in asymptomatic patients were sparse and imprecise; hence, these conclusions apply primarily to symptomatic patients. CONCLUSION: Compared with endarterectomy, carotid artery stenting (CAS) significantly increases the risk of any stroke and decreases the risk of MI. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. This article was published in J Vasc Surg and referenced in Journal of Clinical & Experimental Cardiology

Relevant Expert PPTs

Relevant Speaker PPTs

  • Donald silverberg
    Is correction of iron deficiency a new addition to the treatment of heart failure?
    PPT Version | PDF Version
  • Ahmed Zeidan
    Effects of intravenous iron in chronic kidney disease and heart failure
    PPT Version | PDF Version
  • Nicolae Bacalbasa
    The benefits of surgery for breast cancer liver metastases – a single center experience
    PPT Version | PDF Version
  • Suzi Demirbag
    Indications and effectiveness of the open surgery in vesicoureteral refl ux
    PPT Version | PDF Version
  • Mehmet Ozler
    “Mehmet Ozler-Gulhane-Military-Medical-Academy-Ankara-Turkey-Pinealectomy-Initiates-the-Oxidative-Stress-Response-in-Brain-Tissue-of-Rats-Subject-to-Abdominal-Surgery”
    PPT Version | PDF Version
  • Yosef Yarden
    Classically, the 3’untranslated region (3’UTR) is that region in eukaryotic protein-coding genes from the translation termination codon to the polyA signal. It is transcribed as an integral part of the mRNA encoded by the gene. However, there exists another kind of RNA, which consists of the 3’UTR alone, without all other elements in mRNA such as 5’UTR and coding region. The importance of independent 3’UTR RNA (referred as I3’UTR) was prompted by results of artificially introducing such RNA species into malignant mammalian cells. Since 1991, we found that the middle part of the 3’UTR of the human nuclear factor for interleukin-6 (NF-IL6) or C/EBP gene exerted tumor suppression effect in vivo. Our subsequent studies showed that transfection of C/EBP 3’UTR led to down-regulation of several genes favorable for malignancy and to up-regulation of some genes favorable for phenotypic reversion. Also, it was shown that the sequences near the termini of the C/EBP 3’UTR were important for its tumor suppression activity. Then, the C/EBP 3’UTR was found to directly inhibit the phosphorylation activity of protein kinase CPKC in SMMC-7721, a hepatocarcinoma cell line. Recently, an AU-rich region in the C/EBP 3’UTR was found also to be responsible for its tumor suppression. Recently we have also found evidence that the independent C/EBP 3’UTR RNA is actually exists in human tissues, such as fetal liver and heart, pregnant uterus, senescent fibroblasts etc. Through 1990’s to 2000’s, world scientists found several 3’UTR RNAs that functioned as artificial independent RNAs in cancer cells and resulted in tumor suppression. Interestingly, majority of genes for these RNAs have promoter-like structures in their 3’UTR regions, although the existence of their transcribed products as independent 3’UTR RNAs is still to be confirmed. Our studies indicate that the independent 3’UTR RNA is a novel non-coding RNA species whose function should be the regulation not of the expression of their original mRNA, but of some essential life activities of the cell as a whole.
    PPT Version | PDF Version
  • Ana Domingo Rueda
    Collaborative programme in Pediatric Cardiac Surgery in Ethiopia: Nursery role
    PPT Version | PDF Version
  • Manuele Casale
    The potential role of hyaluronic acid in postoperative radiofrequency surgery for chronic inferior turbinate hypertrophy
    PPT Version | PDF Version
  • Cicek Senture
    Analyzing The Efficiencies Of Discharge Education For The Patients Who Had A Cardiac Surgery
    PPT Version | PDF Version
  • Femi Ehizokhale Osho
    Pain management for surgery and anesthesia
    PPT Version | PDF Version
  • Jean Daniel Eloy
    Surgery Under Regional Anesthesia
    PPT Version | PDF Version
  • Bonnie Molloy, Scott Thornton, Daniel Silasi
    Preventive Anesthesia and Surgical Treatment Interventions during Robotics and Steep Trendelenburg Positioned Surgery
    PPT Version | PDF Version
  • Samar Jabbour-Khoury
    Anesthesia for bariatric surgery: What the occasional anesthesiologist should know
    PPT Version | PDF Version
  • Flavia Secco Tavares de Souza
    A Comparative Study Among Elective Conventional Surgery, Urgency/Emergency Conventional Approaching and Elective Videolaparoscopic Surgery on the Treatment of Hospitalized Patients at First Surgeric Clinic of Federal Hospital of Bonsucesso with a Diagnostic of Colorectal adenocarcinoma, between January 2010 and December 2012
    PPT Version | PDF Version
  • Kawsar Sardar
    Stress Response to Surgery under General Anesthesia in Type 2 Diabetic Patient
    PPT Version | PDF Version

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords