Wenlong Cheng1, Huijun Lu1, Yali Hu2. 1. Department of Vascular Surgery, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province, China. 2. Department of Vascular Surgery, Wuxi People's Hospital, Nanjing Medical University, Jiangsu Province, China. Electronic address: cwl0620@163.com.
Abstract
BACKGROUND: There is a controversy about whether the contralateral carotid occlusion (CO) in patients undergoing carotid endarterectomy (CEA) is associated with worse early and long-term outcomes. The aim of this systematic review and meta-analysis was to investigate the impact of CO on outcomes after CEA. METHODS: PubMed, Embase, and MEDLINE databases were searched until January 2018 for studies comparing early and long-term outcomes of CEA in patients with CO and with patent contralateral carotid (CP). Two independent reviewers identified studies meeting our inclusion/exclusion criteria, extracted relevant data and assessed quality. Fixed- or random-effects models were used to calculate the overall effect estimates. RESULTS: Our literature search identified 35 articles eligible for inclusion in the review and analysis. Patients with CO had higher rate of preoperative symptoms (Stroke + transient ischemic attack [TIA]) (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.11-1.31) and had increased risk of perioperative neurological complications (Stroke + TIA) (OR = 1.63, 95% CI: 1.36-1.94) compared with those with CP. No significant difference in the perioperative mortality rate (OR = 1.40, 95% CI: .99-1.98) and the stroke-free survival rate at 5 years (OR = 1.06, 95% CI: .79-1.40) between 2 groups was identified. CONCLUSIONS: The presence of CO results in higher rate of preoperative symptoms and increases perioperative risk of neurological complications in CEA, but do not have a significant impact on the perioperative mortality rate and the stroke-free survival rate at 5 years. Careful consideration should be given in perioperative care in these patients.
BACKGROUND: There is a controversy about whether the contralateral carotid occlusion (CO) in patients undergoing carotid endarterectomy (CEA) is associated with worse early and long-term outcomes. The aim of this systematic review and meta-analysis was to investigate the impact of CO on outcomes after CEA. METHODS: PubMed, Embase, and MEDLINE databases were searched until January 2018 for studies comparing early and long-term outcomes of CEA in patients with CO and with patent contralateral carotid (CP). Two independent reviewers identified studies meeting our inclusion/exclusion criteria, extracted relevant data and assessed quality. Fixed- or random-effects models were used to calculate the overall effect estimates. RESULTS: Our literature search identified 35 articles eligible for inclusion in the review and analysis. Patients with CO had higher rate of preoperative symptoms (Stroke + transient ischemic attack [TIA]) (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.11-1.31) and had increased risk of perioperative neurological complications (Stroke + TIA) (OR = 1.63, 95% CI: 1.36-1.94) compared with those with CP. No significant difference in the perioperative mortality rate (OR = 1.40, 95% CI: .99-1.98) and the stroke-free survival rate at 5 years (OR = 1.06, 95% CI: .79-1.40) between 2 groups was identified. CONCLUSIONS: The presence of CO results in higher rate of preoperative symptoms and increases perioperative risk of neurological complications in CEA, but do not have a significant impact on the perioperative mortality rate and the stroke-free survival rate at 5 years. Careful consideration should be given in perioperative care in these patients.
Authors: Wanzhong Yuan; Ran Huo; Kaiming Ma; Yunfeng Han; Xiaoliang Yin; Jun Yang; Xihai Zhao; Tao Wang Journal: Front Neurol Date: 2022-08-24 Impact factor: 4.086