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Original Research

Risk of stroke in the periprocedural period: a literature review comparing carotid endarterectomy and stenting

Authors:

Waqqas Patel ,

University of Birmingham, GB
About Waqqas
Medical Student at the University of Birmingham.
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Hanif Marty,

University of Birmingham, GB
About Hanif
Medical Student at the University of Birmingham
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Manjot Singh,

University of Birmingham, GB
About Manjot
Medical Student at the University of Birmingham
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Amandeep Chumber

University of Birmingham, GB
About Amandeep
Medical Student at the University of Birmingham
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Abstract

Background 

Atherosclerosis of the carotid arteries is a pathophysiological process increasing the risk of stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are two recognised procedures indicated by National Institute of Clinical Excellence (NICE) guidelines aiming to reduce the risk of stroke. However, both are associated with periprocedural complications (defined as within 30 days), particularly stroke. This review aims to identify which treatment, CAS or CEA, has a lower risk of periprocedural stroke in patients with symptomatic or asymptomatic carotid artery stenosis.

Methods

NICE Evidence Search identified relevant UK guidelines. Search strategies combining free-text terms searched the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, CINAHL, and EMBASE for systematic reviews post-2011, and RCTs from 2015 onwards. Studies were included if they contained a comparison of CEA vs CAS with regards to periprocedural risk of stroke, and if they contained novel studies not seen in the NICE guidance. English language and full-text limits were applied. 

Results

Searches identified 202 articles. Two reviewers performed independent screening identifying 3 guidelines, 7 systematic reviews, and 1 randomised control trial eligible for inclusion. Guidelines currently advocate usage of both procedures, unlike Scottish Guidelines (SIGN) who only support CEA. Four appraised systematic reviews found a statistically significant increase in stroke probability with CAS (p<0.05). The remaining reviews and RCT did not show a significantly increased risk with CAS (p>0.05).

Discussion

This review’s findings suggest that CAS is associated with an increased risk of periprocedural stroke when compared to CEA. Current UK guidelines by NICE and SIGN may require revisiting and take into account the new evidence not included in the original guidelines. There is a need for ongoing research as stenting technology improves over time.

How to Cite: Patel W, Marty H, Singh M, Chumber A. Risk of stroke in the periprocedural period: a literature review comparing carotid endarterectomy and stenting. The British Student Doctor Journal. 2019;3(1):6–15. DOI: http://doi.org/10.18573/bsdj.29
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Published on 31 Jan 2019.
Peer Reviewed

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