April 2011

Methodological Remarks Concerning the Recent Meta-analysis of Carotid Artery Stenting vs Carotid Endarterectomy

Author Affiliations

Author Affiliations: University of Athens, School of Medicine, Athens, Greece; and Society of Junior Doctors, Athens, Greece.


Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Neurol. 2011;68(4):543-544. doi:10.1001/archneurol.2011.39

We read with great interest the comprehensive meta-analysis by Bangalore et al1 that reached important conclusions regarding outcomes after carotid artery stenting and carotid endarterectomy. Nevertheless, a variety of methodological issues seem worth addressing.

Concerning short-term outcomes, the numbers from the Stenting and Angioplasty With Protection in Patients at High Risk for Endarterectomy trial (Figure 2A) seem questionable, as the original total number of events was 8 of 167 (carotid artery stenting) vs 16 of 167 (carotid endarterectomy); evidently the numbers provided by Bangalore et al1 in symptomatic and asymptomatic patients do not sum to those above. Rather surprisingly, the numbers for the Stent-Protected Angioplasty vs Carotid Endarterectomy (SPACE) trial in 2 distinct outcomes (Figure 2, A and B) were identical (46 of 607 vs 38 of 589); this would necessitate that no myocardial infarction has occurred periprocedurally in SPACE. Regarding Trial of Endarterectomy vs Stenting to Carotid Atherovascular Stenosis–China (TESCAS-C) the numbers provided by Bangalore et al1 seem in discrepancy with the original ones; Figure 2A should ideally read 4 of 82 vs 7 of 84, whereas Figure 2B should read 3 of 82 vs 5 of 84.

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