A comparative study on medium-long term results of conventional and eversion endarterectomy in management of carotid artery stenosis: a meta-analysis

To evaluate the medium-long term effectiveness of eversion (eCEA) and conventional (cCEA) carotid endarterectomy on carotid artery stenosis. We searched MEDLINE (1970-2012.12), Ovid (1970-2012), CBM (1970-2012.12) and CNKI (1970-2012.12) database. Relevant journals and dissertation were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed through software STATA 11.2. A total of 21 studies were deemed eligible (8 617 eCEA and 7 830 cCEA procedures), six of which were randomized and 14 non-randomized. Base on 15 121 patients underwent carotid artery stenosis including 16 447 cases, eCEA was association with a shorter mean operation time (WMD -85.00 min, P < 0.001), internal carotid artery clamp time (WMD -3.9 min, P < 0.01) and less shunt usage (OR = 0.20, P < 0.01). Furthermore, eCEA was associated with significant reduction in 30-day mortality (OR = 0.59, P = 0.013), perioperative stroke (OR = 0.63, P = 0.044), residual restenosis (OR = 0.51, P = 0.019) and carotid artery occlusion (OR = 0.44, P = 0.001). Although eCEA did not reduce medium-long term all-caused mortality (OR = 0.81, P = 0.143) during follow-up time, eCEA presented with a significant reduction in late residual restenosis (OR = 0.34, P < 0.01) and carotid artery occlusion (OR = 0.30, P < 0.01). A sub-analysis was performed on studies directly comparing eCEA with patch CEA (CEA+P), eCEA replicated the finding on perioperative stroke, 30-day mortality, and stroke-related death within short term and late residual restenosis. Concerning outcomes of RCT, eCEA presents with a significant reduction in the residual restenosis (OR = 0.43, 95%CI: 0.27, 0.69, P < 0.01) and carotid artery occlusion (OR = 0.11, 95%CI: 0.02, 0.62, P = 0.012) during following-up time. Eversion CEA compared to conventional CEA may be associated with a short operation time and a short block time. eCEA appears to be associated with better 30-day mortality and stroke outcome than cCEA. Eversion CEA may be more effective for long-term prevention of restenosis, however, in the long term, it is not associated with a reduction in all-cause mortality.