Eversion versus Conventional Carotid Endarterectomy: A Meta-analysis of Randomised and Non-randomised Studies

BackgroundTo compare eversion (ECEA) and conventional (CCEA) carotid endarterectomy from randomised and non-randomised studies.MethodsPooled odds ratios (ORs) with 95% confidence intervals (95%CIs) and numbers needed to treat (NNTs) were appropriately calculated. A sub-analysis was performed on studies directly comparing ECEA vs. patch CEA (PCEA). Meta-regression analysis was performed to examine the effect of potentially meaningful patient-related, procedure-related and definition-related modifiers. Power calculations were also conducted.ResultsA total of 21 studies were deemed eligible (8530 ECEA and 7721 CCEA procedures), seven of which were randomised and 14 non-randomised. ECEA was associated with significant reduction in perioperative stroke (OR = 0.46, 95%CI: 0.35–0.62, NNT = 68, 95%CI: 56–96), death (OR = 0.49, 95%CI: 0.34–0.69, NNT = 100, 95%CI: 85–185) and stroke-related death (OR = 0.40, 95%CI: 0.23–0.67, NNT = 147, 95%CI: 115–270); the results were replicated at the sub-analysis on PCEA. Concerning long-term outcomes, ECEA presented with a significant reduction in late carotid artery occlusion (OR = 0.48, 95%CI: 0.25–0.90, NNT = 143, 95%CI: 100–769) and late mortality (OR = 0.76, 95%CI: 0.61–0.94, NNT = 40, 95%CI: 25–167); the sub-analysis on PCEA replicated only the finding on late mortality. Meta-regression analysis did not point to significant effects mediated by the examined modifiers. Power calculations suggested adequate statistical power.ConclusionsECEA compared to CCEA may be associated with a lower incidence in both short-term and long-term outcomes, which does not seem to be hampered by potentially meaningful modifiers.