Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis
Introduction: The use of an ‘eversion’ technique is not unequivocally proven to be superior to carotid endarterectomy with patch angioplasty. An up-to-date systematic review is needed for evaluation of benefits and harms of these two techniques. Methods: RCTs comparing eversion technique versus enda...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S258984502300026X |
| _version_ | 1797806981514264576 |
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| author | Martijn S. Marsman Jørn Wetterslev Patrick W.H.E. Vriens Ronald L.A.W. Bleys Abdelkarime Kh. Jahrome Frans L. Moll Frederik Keus Michel M.P.J. Reijnen Giel G. Koning |
| author_facet | Martijn S. Marsman Jørn Wetterslev Patrick W.H.E. Vriens Ronald L.A.W. Bleys Abdelkarime Kh. Jahrome Frans L. Moll Frederik Keus Michel M.P.J. Reijnen Giel G. Koning |
| author_sort | Martijn S. Marsman |
| collection | DOAJ |
| description | Introduction: The use of an ‘eversion’ technique is not unequivocally proven to be superior to carotid endarterectomy with patch angioplasty. An up-to-date systematic review is needed for evaluation of benefits and harms of these two techniques. Methods: RCTs comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic and significant (≥50 %) stenosis of the internal carotid artery were enrolled. Primary outcomes were all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes included 30-day stroke and mortality rate, (a) symptomatic arterial occlusion or restenosis, and adverse events not critical for decision making. Results: Four RCTs were included with 1272 surgical procedures for carotid stenosis; eversion technique n = 643 and carotid endarterectomy with patch closure n = 629. Meta-analysis comparing both techniques showed, with a very low certainty of evidence, that eversion technique might decrease the number of patients with serious adverse events (RR 0.47; 95% CI 0.34 to 0.64; p ≤ 0.01). However, no difference was found on the other outcomes. TSA demonstrated that the required information sizes were far from being reached for these patient-important outcomes. All patient-relevant outcomes were at low certainty of evidence according to GRADE. Conclusions: This systematic review showed no conclusive evidence of any difference between eversion technique and carotid endarterectomy with patch angioplasty in carotid surgery. These conclusions are based on data obtained in trials with very low certainty according to GRADE and should therefore be interpreted cautiously. Until conclusive evidence is obtained, the standard of care according to ESVS guidelines should not be abandoned. |
| first_indexed | 2024-03-13T06:15:38Z |
| format | Article |
| id | doaj.art-88caf36f3acb466dbd244bfdfec6e25a |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-03-13T06:15:38Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-88caf36f3acb466dbd244bfdfec6e25a2023-06-11T04:14:57ZengElsevierSurgery Open Science2589-84502023-06-011399110Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysisMartijn S. Marsman0Jørn Wetterslev1Patrick W.H.E. Vriens2Ronald L.A.W. Bleys3Abdelkarime Kh. Jahrome4Frans L. Moll5Frederik Keus6Michel M.P.J. Reijnen7Giel G. Koning8Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands; Corresponding author at: Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.Private Office, Tuborg Sundpark, Hellerup, DenmarkDepartment of Vascular Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Medical & Clinical Psychology, Tilburg University, The NetherlandsDepartment of Anatomy, University Medical Centre Utrecht, Utrecht, the NetherlandsDepartment of Vascular Surgery, HFG, Medical Centre Leeuwarden, Leeuwarden, the NetherlandsDepartment of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the NetherlandsDepartment of Critical Care, University of Groningen, University Medical Centre Groningen, the NetherlandsDepartment of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands; Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the NetherlandsDepartment of Vascular Surgery, Euregio Hospital, Nordhorn, GermanyIntroduction: The use of an ‘eversion’ technique is not unequivocally proven to be superior to carotid endarterectomy with patch angioplasty. An up-to-date systematic review is needed for evaluation of benefits and harms of these two techniques. Methods: RCTs comparing eversion technique versus endarterectomy with patch angioplasty in patients with a symptomatic and significant (≥50 %) stenosis of the internal carotid artery were enrolled. Primary outcomes were all-cause mortality rate, health-related quality of life and serious adverse events. Secondary outcomes included 30-day stroke and mortality rate, (a) symptomatic arterial occlusion or restenosis, and adverse events not critical for decision making. Results: Four RCTs were included with 1272 surgical procedures for carotid stenosis; eversion technique n = 643 and carotid endarterectomy with patch closure n = 629. Meta-analysis comparing both techniques showed, with a very low certainty of evidence, that eversion technique might decrease the number of patients with serious adverse events (RR 0.47; 95% CI 0.34 to 0.64; p ≤ 0.01). However, no difference was found on the other outcomes. TSA demonstrated that the required information sizes were far from being reached for these patient-important outcomes. All patient-relevant outcomes were at low certainty of evidence according to GRADE. Conclusions: This systematic review showed no conclusive evidence of any difference between eversion technique and carotid endarterectomy with patch angioplasty in carotid surgery. These conclusions are based on data obtained in trials with very low certainty according to GRADE and should therefore be interpreted cautiously. Until conclusive evidence is obtained, the standard of care according to ESVS guidelines should not be abandoned.http://www.sciencedirect.com/science/article/pii/S258984502300026XCarotid endarterectomySystematic reviewEversion techniquePatchStenosisBlood pressure |
| spellingShingle | Martijn S. Marsman Jørn Wetterslev Patrick W.H.E. Vriens Ronald L.A.W. Bleys Abdelkarime Kh. Jahrome Frans L. Moll Frederik Keus Michel M.P.J. Reijnen Giel G. Koning Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis Surgery Open Science Carotid endarterectomy Systematic review Eversion technique Patch Stenosis Blood pressure |
| title | Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis |
| title_full | Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis |
| title_fullStr | Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis |
| title_full_unstemmed | Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis |
| title_short | Eversion technique versus traditional carotid endarterectomy with patch angioplasty: a systematic review with meta-analyses and trial sequential analysis |
| title_sort | eversion technique versus traditional carotid endarterectomy with patch angioplasty a systematic review with meta analyses and trial sequential analysis |
| topic | Carotid endarterectomy Systematic review Eversion technique Patch Stenosis Blood pressure |
| url | http://www.sciencedirect.com/science/article/pii/S258984502300026X |
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