Systematic comparison of the early outcome of angioplasty and endarterectomy for symptomatic carotid artery disease

Background and Purpose-Endoluminal treatment is being increasingly used for carotid artery disease. The aim of this study was to compare the stroke an d death risk within 30 days of endovascular treatment or endarterectomy for symptomatic carotid artery disease. Methods-A systematic comparison of the 30-day outcome of angioplasty with o r without stenting and endarterectomy for symptomatic carotid artery diseas e reported in single-center studies, published since 1990, was performed. Results-Thirty-three studies (13 angioplasty and 20 carotid endarterectomy) were included in this analysis. Carotid stents were deployed in 44% of ang ioplasty patients. Mortality within 30 days of angioplasty was 0.8% compare d with 1.2% after endarterectomy (OR 0.68, 95% CI 0.43 to 1.05; P=0.6). The stroke rate was 7.1% for angioplasty and 3.3% for endarterectomy (OR 2.22, CI 1.62 to 3.04; P<0.001), while the risk of fatal or disabling stroke was 3.2% and 1.6%, respectively (OR 2.09, CI 1.3 to 3.33, P<0.01). The risk of stroke or death was 7.8% for angioplasty and 4% for endarterectomy (OR 2.0 2, CI 1.49 to 2.75; P<0.001), while disabling stroke or death was 3.9% afte r angioplasty and 2.2% after endarterectomy (OR 1.86, CI 1.32 to 2.84; P<0. 01). Conclusions-In the treatment of symptomatic carotid artery disease, the ris k of stroke is significantly greater with angioplasty than carotid endarter ectomy. At present, carotid angioplasty is not recommended for the majority of patients with symptomatic carotid artery disease.