Schweizer Archiv für Neurologie und Psychiatrie ... - Sanp.ch

Posters SNS
Background: Recent randomised controlled trials (RCTs)
have shown a higher short-term risk of stroke associated with
stenting (CAS) compared with endarterectomy (CEA) for the
treatment of symptomatic carotid stenosis. However, trials
were underpowered to investigate whether CAS may be a safe
alternative to CEA in specific patient subgroups. We therefore
performed a prospective individual patient data meta-analysis of
three RCTs.
Methods: individual data from all 3433 patients with symptomatic
carotid stenosis randomised in the contributing trials were
pooled and analysed with fixed-effect binomial regression
models adjusted for source trial. The primary outcome event
was any stroke or death. The analysis by intention-to-treat (ITT)
included all patients and outcome events occurring between
randomisation and 120 days thereafter. The per-protocol (PP)
analysis was restricted to patients receiving the allocated
treatment and events occurring within 30 days after treatment.
Results: In the first 120 days after randomisation, any stroke
or death occurred significantly more often in the CAS group
(153/1725 [8.9%]) than in the CEA group (98/1708 [5.7%],
risk ratio (RR) 1.54, [95% confidence interval 1.21, 1.97],
p = 0.0004). Of all tested subgroup variables, only age
significantly modified the treatment effect: in patients