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<p><b>BACKGROUND</b>Carotid stenosis is one of the common reasons for patients with ischemic stroke, and the two invasive options carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the most popular treatments. But the relative efficacy and safety of the methods are not clear.</p><p><b>METHODS</b>About 521 articles related to CAS and CEA for carotid stenosis published in 1995 - 2011 were retrieved from MEDLINE, Cochrane Library (CL), and China National Knowledge Infrastructure (CNKI) China Journal Full-Test database. Of them, eight articles were chosen. Meta-analysis was used to assess the relative risks.</p><p><b>RESULTS</b>The eight studies included 3873 patients with symptomatic carotid artery stenosis, including 1941 cases in the carotid stent angioplasty group, and 1932 cases in the carotid endarterectomy group. Fixed effect model analysis showed that within 30 days of incidence of all types of strokes, surgery was significantly highly preferred in CAS patients (CAS group) than the CEA patients (CEA group), and the difference was statistically significant (relative ratio (RR) = 1.80, 95% confidence interval (CI): 1.380 - 2.401, P < 0.0001). But the incidence of death in the two groups is not showed and is not statistically significant after 30 days (RR = 1.52, 95%CI: 0.82 - 2.82, P = 0.18). The rate of cranial nerve injury in the CAS group is lower than the CEA group (RR = 0.14, 95%CI: 0.05 - 0.43, P = 0.0005). The incidence of CAS patients with myocardial infarction is lower than the CEA group after 30 days, but statistically meaningless (RR = 0.22, 95%CI: 0.05 - 1.02, P = 0.05). The stroke or death in CAS patients were higher than the CEA group after 1 year of treatment (RR = 2.58, 95%CI: 1.03 - 6.48, P = 0.04).</p><p><b>CONCLUSIONS</b>Compared to CAS, carotid endarterectomy is still the preferred treatment methodology of symptomatic carotid artery stenosis. Future meta-analyses should then be performed in long-term follow-up to support this treatment recommendation.</p>
Subject(s)
Humans , Carotid Stenosis , General Surgery , Therapeutics , Endarterectomy, Carotid , StentsABSTRACT
Objectives: To observe the efficacy of encephalo-duro-arterio-synangiosis (EDAS) or in combination with endovascular embolization in the treatment of patients with moyamoya disease complicating intracranial aneurysms and to investigate the therapeutic strategy for moyamoya disease complicating intracranial aneurysms. Methods: A total of 27 patients (28 aneurysms) with moyamoya disease complicating intracranial aneurysms confirmed by cerebral angiography were recruited. Nineteen patients were presented as hemorrhagic disease and 8 patients were presented as cerebral ischemic disease. For 10 patients with arterial trunk aneurysms, they were treated with endovascular embolization, and then were treated with unilateral EDAS 7-10 days after embolization. Three months later the contralateral EDAS were performed. As for the aneurysms located in the peripheral arteries (n = 17) , if the embolization could be performed (n =9), the aneurysms were obliterated with coils or ONYX glue, otherwise the ipsilateral EDAS should be performed (n = 8). Results: Circled digit oneEighteen aneurysms in 19 patients (20 aneurysms) were embolized successfully and 2 patients were failed (one aneurysm in lenticulostriate artery and the other in posterior choroidal artery). After embolization, 3 patients with peripheral aneurysms had contralateral limb weakness, and recovered within 1 week to 3 months. Circled digit twoThere was no bleeding and rebleeding for 10-60 months follow-up after EDAS. Among the patients with cerebral ischemia, 2 had recurrence of TIA within 3 months after EDAS, but they had no recurrence of the symptom after 3 months. Circled digit threeThe angiography of 21 patients (21 aneurysms) 3 to 15 months after EDAS showed that the aneurysms treated with embolization did not reoccur (12 aneurysms); 8 of 9 peripheral aneurysms without eml)olization were disappeared; and significant retention of contrast agent in 1 aneurysm was found. All 21 patients showed better communication between the superficial temporal artery and intracranial angiogenesis. Conclusion: Endovascular embolization is one of the important means for the treatment of moyamoya disease complicating intracranial aneurysms. EDAS may promote the occlusion of peripheral aneurysms.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of treating severe and chronic vertebral compressive fractures in the elderly with percutaneous vertebroplasty.</p><p><b>METHODS</b>Sixteen patients who suffered from severe back pain and whose daily living was badly affected were retrospectively reviewed. The average age was 72.5 years, the average disease history was 19 months, and the average compressive rate of the affected vertebral bodies was 74.1%.</p><p><b>RESULTS</b>Nineteen affected compressive vertebral bodies in 16 cases were treated with percutaneous vertebroplasty. All the procedures were successful without any complication. After 3.5-7 ml of cement was injected into the lesions, complete relief was achieved in 3 cases, remarkable relief was achieved in 11 cases, and improvement was observed in 2 cases. The scores of 6-point Behavioral Rating Scale and Activity of Daily Living (ADL) declined significantly after the treatment (P < 0.001).</p><p><b>CONCLUSION</b>Percutaneous vertebroplasty can significantly improve the symptoms and quality of life in the elderly patients with severe and chronic vertebral compressive fractures.</p>