Safety and Efficacy of Early Carotid Endarterectomy in Patients with Symptomatic Carotid Artery Stenosis: A Meta-Analysis

Abstract

Background and Purpose. This study is aimed at assessing the differences in postoperative stroke, myocardial infarction (MI), and mortality in patients with symptomatic carotid artery stenosis (sCAS) treated with early or late carotid endarterectomy (CEA) to determine and compare the safety of different operation timing. Design. A systematic document retrieval of studies published in the past 10 years reporting periprocedural stroke/mortality/MI after carotid endarterectomy (CEA) related to the time between CEA and qualifying neurological symptoms. The application database has "PubMed, EMbase and Cochrane databases."RevMan5.3 software provided by the Cochrane collaboration was used for meta-analysis. Results. A systematic literature search was conducted in databases. A total of 10 articles were included in this study. They were divided into early CEA and delayed CEA with operation within 48 h, 1 w, or 2 w after onset of neurological symptoms. Incidence of the postoperative stroke in patients undergoing delayed CEA (≥48 h) was significantly higher than patients with delayed CEA (<48 h) (OR=2.14, 95% CI: 1.43-3.21, P=0.0002). The postoperative mortality of patients after delayed CEA (≥48 h) was significantly higher than patients after early CEA (<48 h) (OR=1.35, 95% CI: 1.06-1.71, P=0.02). The risk of postoperative mortality of patients treated with delayed CEA (≥7 d) was significantly higher than patients after the early CEA group (<7 d) (OR=1.69, 95% CI: 1.21-2.32, P=0.001). Conclusion. Early CEA is safe and effective for a part of patients with symptomatic carotid stenosis, but a comprehensive preoperative evaluation of patients with carotid stenosis must be performed.