Carotid endarterectomy: eversion endarterectomy is not clearly better than conventional techniques

Clinical bottom line (level 1a)

  1. Patients undergoing carotid endarterectomy who have eversion compared with conventional endarterectomy are less likely to have a restenosis > 50% (NNT = 38 at 11-40 months) .
  2. There is no clear difference in peri-operative or post-operative strokes, death or local complications between the two groups.
Cao et al: Cochrane Library 2001; 1 : -
Expires November 2003

The study

Systematic review of all randomised trials of
  • Patients: undergoing carotid endarterectomy
  • Intervention: eversion carotid endarterectomy compared with conventional carotid endarterectomy
  • Outcome: stroke, death, carotid restenosis/occlusion, local complications

    Articles found in ?all languages using Medline, Cochrane Stroke Groups Trials Register, to December 1999 (search terms: detailed in text ) and hand-searching 8 surgical journals and conference proceedings. Researchers were contacted to identify other studies.

    Selection criteria: by 2 independent reviewers
    Appraisal criteria: by 2 independent reviewers based on randomisation, concealment of allocation, blinding, loss to follow-up, intention-to-treat analysis
    Articles excluded if:
    • focused on combined carotid surgery
    • carotid bifurcation completely resected and replaced by a graft
    • only external carotid artery endarterectomies performed
    • epiaortic vessels different from the internal carotid artery involved (e.g. subclavian or common carotid)
    • duplicate articles


    5 studies involving 2465 patients and 2590 arteries

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    perioperative stroke 30 days 24/1173
    (2.0%)    		 0.70
    (0.38 to 1.29)     		170
    (NNT = 80 to infinity;
    NNH = 170 to infinity)
    perioperative death 30 days 8/1173
    (0.68%)    		 0.86
    (0.31 to 2.37)     		1100
    (NNT = 210 to infinity;
    NNH = 110 to infinity)
    stroke during follow-up 11-40 months 19/1097
    (1.7%)    		 0.84
    (0.43 to 1.64)     		370
    (NNT = 100 to infinity;
    NNH = 93 to infinity)
    restenosis > 50% 11-40 months 66/1267
    (5.2%)    		 0.48
    (0.32 to 0.72)     		38
    (29 to 71)

    Comments

    1. There was no clear difference between the two groups for local complications (cranial nerve injuries or neck haematoma)

    Citation

    1. Cao PG, De Rango P, Zannetti S, et al: eversion versus conventional carotid endarterectomy for preventing stroke (Cochrane Review). Cochrane Library 2001; 1 : -
    Search Terms: endarterectomy in Cochrane Library
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient undergoing carotid endarterectomy
    Intervention or Exposure eversion carotid endarterectomy
    Comparison conventional carotid endarterectomy
    Outcome death, stroke, local complications
    		•