Journal of vascular surgery
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Review Meta Analysis Comparative Study
Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results.
Endovascular stenting has emerged as an alternative to open repair in patients requiring surgery for thoracic aortic pathology. A number of comparative series have been published but, to date, there has been no meta-analysis comparing outcomes following stenting as opposed to open surgery. ⋯ Endovascular thoracic aortic repair reduces perioperative mortality and neurological morbidity in patients with descending thoracic aortic aneurysms. There may be less benefit in other thoracic aortic conditions.
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Review Meta Analysis
Clinical results of carotid artery stenting compared with carotid endarterectomy.
Carotid artery stenting (CAS) is an alternative to carotid endarterectomy (CEA) for treating carotid artery stenosis. We conducted a systematic review and meta-analysis of the clinical trials to date comparing these two procedures to determine their relative safety and efficacy. ⋯ Meta-analysis of trials to date shows CAS is associated with higher 30-day risk of stroke/death compared with CEA. Thus, for the patient at average surgical risk, the role of CAS is unproven, especially for symptomatic patients. And for the patient at high surgical risk, the role of any intervention is uncertain in the setting of competing comorbidities. The results of ongoing clinical trials in this area will likely provide additional evidence to support treatment choices for carotid artery stenosis.
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Meta Analysis Comparative Study
Safety of endovascular treatment of carotid artery stenosis compared with surgical treatment: a meta-analysis.
Since publication of previous meta-analyses comparing endovascular and surgical treatment of patients with carotid artery stenosis, two further large-scale trials have been conducted, almost doubling the number of patients available for analysis. Therefore, it is justified to update these meta-analyses. ⋯ The expressiveness of this meta-analysis is limited by the heterogeneity of some tests. The main result is that surgical treatment still remains the gold standard for treatment of patients with symptomatic carotid artery stenosis, who do not have an increased surgical risk. Carotid artery stenting is neither safer than nor as safe as carotid endarterectomy in large clinical trials when short-term stroke and death rates are taken into account. Further recruitment into ongoing randomized trials is strongly recommended.
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Comment Letter Meta Analysis
Regarding "Screening for abdominal aortic aneurysm reduces both aneurysm-related and all-cause mortality".