The Role of Carotid Stump Pressure in Carotid Endarterectomy: A Systematic Review and Meta-Analysis.
| Autor: | Kordzadeh A; Mid Essex Hospitals Services NHS Trust, Department of Vascular, Endovascular and Renal Access Surgery, Broomfield Hospital, Essex, UK., Abbassi OA; Mid Essex Hospitals Services NHS Trust, Department of Vascular, Endovascular and Renal Access Surgery, Broomfield Hospital, Essex, UK., Prionidis I; Mid Essex Hospitals Services NHS Trust, Department of Vascular, Endovascular and Renal Access Surgery, Broomfield Hospital, Essex, UK., Shawish E; Department of Vascular Surgery, Royal Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK. |
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| Jazyk: | angličtina |
| Zdroj: | Annals of vascular diseases [Ann Vasc Dis] 2020 Mar 25; Vol. 13 (1), pp. 28-37. |
| DOI: | 10.3400/avd.ra.19-00100 |
| Abstrakt: | This review evaluates the carotid stump pressure (CSP)'s role as a single parameter at any given pressure as an indicator for selective shunting, or vice versa, in carotid endarterectomy (CEA). A systematic review of literature in MEDLINE and the Cochrane Library from 1969 to 2019 was conducted. The primary end point was set at 0 to 30-day mortality, ischemic stroke (IS), transient ischemic attack (TIA), and a secondary point at recognition of an optimal CSP pressure. The data was subjected to meta-analytics. The odds ratio (OR) was reported at 95% confidence interval (CI). This study has been registered with PROSPERO: CRD42019119851. The pooled analysis on the primary endpoint of IS demonstrated higher incidence of stroke in shunted CEAs solely based on CSP measurement alone (OR, 0.14, 95%CI: 0.08-0.24, I 2 =48%, p<0.001). Sub group analysis demonstrated similar patterns at 25 mmHg (OR, 0.06, 95%CI: 0.01-0.5, p<0.01), 30 mmHg (OR, 0.07, 95%CI: 0.01-0.63, p=0.02) and 40 mmHg (OR, 0.23, 95%CI: 0.09-0.57, p<0.01). This effect on end points of mortality and TIA demonstrated no benefit in either direction. CSP, as a single criterion, is not a reliable parameter in reduction of TIA, mortality, and IS at any given pressure range. Competing Interests: Disclosure StatementAll authors have no conflict of interest. (Copyright © 2020 Annals of Vascular Diseases.) |
| Databáze: | MEDLINE |
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