Publications by authors named "Theofilos Karasavvidis"

14 Publications

  • Page 1 of 1

Relatively Low Rate of Heterotopic Ossification Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-analysis.

J Am Acad Orthop Surg Glob Res Rev 2021 07 22;5(7). Epub 2021 Jul 22.

From the Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY (Dr. Gkiatas, Mr. Xiang, Mr. Windsor, Dr. Malahias, Dr. Tarity, and Dr. Sculco), and the School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece (Mr. Karasavvidis).

Background: Heterotopic ossification (HO) is abnormal growth of ectopic bone and negatively affects the outcomes after total knee arthroplasty (TKA). This systematic review and meta-analysis were performed to characterize the prevalence and severity of HO after primary TKA.

Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient demographics, publication year, and HO prevalence after a primary TKA were recorded. A meta-analysis was performed to determine the overall prevalence of HO formation, and a subanalysis compared the studies published in different timeframes to determine whether a temporal effect exists for HO prevalence.

Results: Two thousand nine hundred eighty-eight patients underwent primary TKA across the included studies. Fourteen percent of patients (9% to 20%; I2: 93.68%) developed HO postoperatively during a mean follow-up of 40.1 months (11 to 108 months). HO rates seemed to decrease in studies published in more recent years, with a pooled HO prevalence of 5% (0% to 13%; I2: 92.26%) among studies published in the past 15 years compared with 18% (12% to 25%; I2: 92.49%) among studies published before then.

Conclusion: Although studies reported a relatively low overall rate of HO after a primary TKA, the absence of a single, standardized classification system precludes the comparisons of HO severity between studies. Overall, HO prevalence seems to have decreased over time, likely reflecting the changes in perioperative medication protocols.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301284PMC
July 2021

Use of elevated liners in primary total hip arthroplasty: a systematic review of the literature.

Eur J Orthop Surg Traumatol 2021 May 29. Epub 2021 May 29.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA.

Purpose: Instability remains one of the most frequent complications requiring revision surgery after primary total hip arthroplasty (THA). Elevated liners are often utilized to reduce the risk of dislocation; however, the literature is inconclusive, with no systematic reviews summarizing the data. Thus, this systematic review aimed to establish a consensus for the efficacy of elevated liners in primary THA by determining rates of overall revision and revision specifically for recurrent dislocation.

Materials And Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies reporting on the use of elevated liners in primary total hip arthroplasty were identified through May 2020. A random effects model meta-analysis was conducted, and the I statistic was used to assess for heterogeneity.

Results: Eight studies met inclusion criteria, and overall, 26,507 patients undergoing primary THA with use of an elevated liner were included. In aggregate, the most common cause of revision was recurrent hip dislocation (1.3%, N = 82/6,267) followed by joint infection (1.2%, N = 45/3,772) and acetabular loosening (0.3%, N = 10/3,772). Notably, elevated liners were associated with a lower risk of revision for recurrent dislocation compared to neutral liners (HR: 0.74; 95% CI: 0.55-1.00; p = 0.048).

Conclusion: This review found that after primary THA with the use of elevated liners, hip dislocation and prosthetic joint infection continued to be the most frequent reasons for revision surgery. However, elevated liners had a lower risk of revision for recurrent dislocation compared to neutral liners.
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http://dx.doi.org/10.1007/s00590-021-03023-yDOI Listing
May 2021

Total knee arthroplasty in dialysis patients: Is it safe? A systematic review of the literature.

J Orthop 2021 May-Jun;25:199-206. Epub 2021 May 14.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.

Purpose: This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face.

Results: The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N = 925/3702), with incidence rates of 2.5%(N = 92/3702) for periprosthetic joint infection, 3.7%(N = 71/1895) for reoperations, and 2.5%(N = 90/3578) for mortality.

Conclusion: Patients on dialysis for ESRD face significant mortality rates after primary TKA, in addition to other major complications. Careful counseling regarding risks and benefits should be provided prior to TKA in this population.
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http://dx.doi.org/10.1016/j.jor.2021.05.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144102PMC
May 2021

Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases.

Arch Orthop Trauma Surg 2021 Apr 13. Epub 2021 Apr 13.

Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.

Background: The evolution in total knee arthroplasty (TKA) includes the highly cross-linked polyethylene (HXLPE) which has been reported as an effective manner to reduce the wear of the polyethylene and the osteolysis. The purpose of the present study is to synthesize the results of comparative studies between HXLPE and conventional polyethylenes and determine their effect in primary TKA.

Methods: The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "cross-linked", "polyethylene", "HXLPE", "conventional", "total knee arthroplasty", "TKA", "total knee replacement" and "TKR" combined with Boolean operators AND and OR.

Results: Ten studies met the inclusion criteria and were included in the present meta-analysis with 962,467 patients. No significant difference was found regarding the revision rate for any reason between the patients who received HXLPE and those with conventional liner (OR 0.67; 95% CI 0.39-1.18; I: 97.7%). In addition, there was no difference regarding the radiolucent lines between the two types of liners (OR 0.54; 95% CI 0.20-1.49; I: 69.4%). However, with data coming from seven studies enrolling a total of 411,543 patients, it was demonstrated that patients who received HXLPE were less likely to be revised due to aseptic loosening compared to the patients with conventional liners (OR 0.35; 95% CI 0.31-0.39; I: 0.0%).

Conclusion: The present meta-analysis showed that regarding the overall revision rate and radiographic outcomes there was no significant difference between the two types of liners. On the other hand, the significantly less revision rate due to loosening supports the routine continued use of HXLPE in primary TKA.
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http://dx.doi.org/10.1007/s00402-021-03887-zDOI Listing
April 2021

Reply by Authors.

J Urol 2021 04 3;205(4):966. Epub 2021 Feb 3.

Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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http://dx.doi.org/10.1097/JU.0000000000001548.02DOI Listing
April 2021

Does Ureteral Stenting Increase the Risk of Metachronous Upper Tract Urothelial Carcinoma in Patients with Bladder Tumors? A Systematic Review and Meta-analysis.

J Urol 2021 04 7;205(4):956-966. Epub 2020 Dec 7.

Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Purpose: Ureteral stenting in patients with bladder cancer may become necessary in order to protect the ureteral orifice during transurethral resection of the tumor or for relief of upper urinary tract obstruction. However, it is believed to increase metachronous upper tract urothelial carcinoma risk.

Materials And Methods: We performed a systematic review and meta-analysis of studies comparing ureteral stenting versus nephrostomy or no drainage with regard to the risk of metachronous upper tract urothelial carcinoma. Records were identified through database searches and sources of grey literature up to October 2020 (PROSPERO: CRD42020178298).

Results: Five studies (3,309 individuals) were included. Overall, 278 ureteral stents were placed and 20 (7.2%) patients developed metachronous upper tract urothelial carcinoma, while 131 patients were treated with nephrostomy and 3 (2.3%) cases of metachronous upper tract urothelial carcinoma occurred. Patients treated with ureteral stents had a higher likelihood of metachronous upper tract urothelial carcinoma compared to no stents (OR: 3.49, 95% CI: 1.43-8.48, I=52%) and no upper urinary tract drainage (OR: 3.37, 95% CI: 1.49-7.63, I=45%). No difference with regard to metachronous upper tract urothelial carcinoma was observed between stent and nephrostomy (OR: 3.07, 95% CI: 0.41-22.98, I=54%). For the same outcomes, no difference was noted for patients with hydronephrosis. The level of evidence for all measures was evaluated as low.

Conclusions: Stenting as a preventive measure after resection of tumors involving the orifice should be avoided, when possible, as it increases the risk of metachronous upper tract urothelial carcinoma. In cases of hydronephrosis, drainage with either nephrostomy or stent is recommended depending on individual patient cases as both interventions do not differ regarding metachronous upper tract urothelial carcinoma risk.
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http://dx.doi.org/10.1097/JU.0000000000001548DOI Listing
April 2021

Platelet-Rich Plasma Combined With Hyaluronic Acid Improves Pain and Function Compared With Hyaluronic Acid Alone in Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Arthroscopy 2021 04 3;37(4):1277-1287.e1. Epub 2020 Dec 3.

Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To evaluate the efficacy of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) injections versus HA injections alone for the management of knee osteoarthritis (OA).

Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies directly comparing combined PRP-HA injections with HA injections alone were identified through a search of PubMed, Scopus, and Cochrane Central databases from inception to May 2020. A random effects model meta-analysis was conducted and the I statistic was used to assess for heterogeneity.

Results: Four studies comprising 377 patients (PRP-HA: 193, HA: 184) with knee OA ranging from I-IV Kellgren-Lawrence grading scale were included. The final follow-up was 12 months in 3 studies and 6 months in 1 study. Patients who received PRP combined with HA had significantly greater improvements compared with those injected with HA alone in terms of visual analog scale scores at 3-month (standardized mean difference [SMD] 1.13; 95% confidence interval [CI] 0.56-1.70; I = 56.7%; P < .001), 6-month (SMD 1.08; 95% CI 0.54-1.62; I = 67.9%; P < .001), and 12-month (SMD 1.13; 95% CI 0.74-1.52; I = 0.0%; P < .001) and 12-month Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning (SMD 0.91; 95% CI 0.65-1.17; I = 0.0%; P < .001) and 12-month WOMAC stiffness (SMD 1.09; 95% CI 0.80-1.38; I = 0.0%; P < .001) scores. No difference was identified in terms of 12-month WOMAC pain score (SMD 0.36; 95% CI -0.19 to 0.91; I = 74.1%; P = .195).

Conclusions: Symptomatic patients with knee OA who were injected with a combination of PRP and HA demonstrated greater improvement in pain and function compared with patients who received HA injections only, as assessed by 3-, 6-, and 12-month visual analog scale scores and 12-month WOMAC physical function and stiffness scores. This study provides encouraging evidence for the use of the combined PRP-HA injections in the management of symptomatic patients with knee OA.

Level Of Evidence: III (meta-analysis of randomized and non-randomized comparative trials).
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http://dx.doi.org/10.1016/j.arthro.2020.11.052DOI Listing
April 2021

Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations.

J Exp Orthop 2020 Jul 19;7(1):52. Epub 2020 Jul 19.

School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece.

Purpose: To provide evidence-based recommendations for patients with severe knee osteoarthritis (OA), who had their knee surgery postponed due to the COVID-19 pandemic.

Methods: PubMed/Medline, Scopus and Cochrane Central databases were systematically reviewed for studies reporting outcomes of home-based treatments for knee OA. Due to between-study differences in treatment strategy and reporting methods the results were not pooled and findings of the current review were presented in a narrative manner.

Results: The comprehensive literature search yielded 33 eligible studies that were included in this review. Management is performed at home and consists of exercise, proper nutrition, physical therapy and use of corrective and assistive orthotics. Virtual education on self-management strategies should be part of coping with knee OA. Initiating an exercise programme involving gymnastics, stretching, home cycling and muscle strengthening is highly recommended. Obese patients are encouraged to set weight loss goals and adopt a healthy diet. Potential benefits but weak evidence has been shown for the use of knee braces, sleeves, foot orthotics or cushioned footwear. Walking aids may be prescribed, when considered necessary, along with the provision of instructions for their use.

Conclusion: When bridging the time to rescheduled surgery, it is essential to use appropriate home-based tools for the management of knee OA if pain is to be reduced and need for analgesics or opioid use is to be diminished while maintaining or even improving the functioning and avoiding further limitation of range of motion and subsequent muscular atrophies. Finally, none of these treatments may completely substitute for the life-changing effect of a total knee arthroplasty in patients with severe knee OA. Hence, the subsequent goal is to gradually and safely reinstate elective surgery.
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http://dx.doi.org/10.1186/s40634-020-00271-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369444PMC
July 2020

Meniscofibular ligament: how much do we know about this structure of the posterolateral corner of the knee: anatomical study and review of literature.

Surg Radiol Anat 2020 Oct 29;42(10):1203-1208. Epub 2020 Mar 29.

Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloníki, Greece.

Purpose: The present study is a systematic review of a relatively unknown structure of the posterolateral corner of the knee, the meniscofibular ligament (MFL), aiming at summarizing and broadening current scientific knowledge regarding this ligament anatomy, function, imaging and injury.

Materials And Methods: A systematic review was performed according to the PRISMA guidelines. Medline (PubMed) and Cochrane Library databases were reviewed for every kind of study reporting on the MFL through December 2019. Due to between-study differences in (anatomy, function, imaging, injury) examining the ligament, the findings were summarized from each study, but the results were not pooled.

Results: The MFL is a ligament extending between the inferolateral portion of lateral meniscus, just anterior to the popliteus tendon, and the fibular head. It provides stability to the posterolateral corner of the knee joint, it can be demonstrated in magnetic resonance imaging and magnetic resonance arthrography and has a potential role in lateral meniscus injuries. Further research is required to clearly understand the prognosis and management of MFL injury.

Conclusion: The current systematic review, focusing only on the MFL of the knee, summarizes the existing knowledge on anatomy, gross morphology, histology, function, biomechanics and imaging and contributes to the further understanding of the MFL.
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http://dx.doi.org/10.1007/s00276-020-02459-xDOI Listing
October 2020

Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis of Stent Retrievers vs Direct Aspiration vs a Combined Approach.

Neurosurgery 2020 04;86(4):464-477

Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia.

Background: Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion.

Objective: To compare the safety and efficacy profile of the different mechanical thrombectomy strategies.

Methods: A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32).

Conclusion: Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.
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http://dx.doi.org/10.1093/neuros/nyz258DOI Listing
April 2020

Endovascular reconstruction of extracranial traumatic internal carotid artery dissections: a systematic review.

Neurosurg Rev 2020 Jun 22;43(3):931-940. Epub 2019 Mar 22.

Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA.

Extracranial internal carotid artery dissection (ICAD) is a potential source of morbidity and mortality in trauma patients and requires high degree of suspicion for diagnosis after the initial presentation. Occasionally, if standard therapy is contraindicated, endovascular reconstruction is a treatment option. The aim of this systematic review was to report clinical and radiographic outcomes following endovascular repair of ICAD of traumatic and iatrogenic etiology. A comprehensive systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched. Twenty-four studies comprising 191 patients (204 lesions) were included; 179 underwent traditional carotid artery stenting (CAS), whereas 12 patients underwent flow diversion with the pipeline embolization device (PED). In total, 75.7% of the CAS group and 66.6% of the PED group presented with ICAD-related symptomatology. Concomitant pseudoaneurysms were identified in 61.9% and 78.5% of lesions in the CAS and PED group, respectively. Adverse event rates among CAS-treated lesions after 30-day follow-up were below 2.2% for stroke, transient ischemic attack, and mortality. During follow-up in the CAS group, there was no incidence of ICAD-related stroke or death and 2.2% of patients underwent a repeat CAS procedure. In the PED group, no patient suffered stroke or death in the reported follow-up. In the PED cohort, there was an adequate occlusion rate and no patient had to be retreated. Endovascular reconstruction of traumatic or iatrogenic ICAD appears safe. This approach demonstrated acceptable short- and long-term clinical and radiographic outcomes in both groups.
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http://dx.doi.org/10.1007/s10143-019-01092-6DOI Listing
June 2020

A meta-analysis of randomized trials comparing bovine pericardium and other patch materials for carotid endarterectomy.

J Vasc Surg 2018 10;68(4):1241-1256.e1

Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa.

Objective: Patch angioplasty during carotid endarterectomy is commonly used to treat symptomatic and asymptomatic carotid artery stenosis. The objective of the present study was to compare the different patch materials that are currently available (synthetic vs venous vs bovine pericardium) in terms of short- and long-term outcomes.

Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and eligible randomized control trials were identified through a comprehensive search of PubMed, Scopus, and Cochrane Central published until September 2017. A meta-analysis was conducted with the use of a random effects model. The I statistic was used to assess for heterogeneity. The primary study end point was the incidence of long-term restenosis. Secondary study end points were 30-day stroke, transient ischemic attack (TIA), myocardial infarction, neck wound infection, local hematoma, carotid artery thrombosis, cranial nerve injury, long-term stroke incidence, and death.

Results: Eighteen studies and 3234 patients were included. The risk of 30-day stroke (relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.19; I = 0%), TIA (RR, 1.14; 95% CI, 0.41-3.19; I = 0%), myocardial infarction (odds ratio, 0.75; 95% CI, 0.14-3.97; I = 0%), death (RR, 0.53; 95% CI, 0.21-1.34; I = 0%), wound infection (RR, 1.84; 95% CI, 0.43-7.81; I = 0%), carotid artery thrombosis (RR, 1.47; 95% CI, 0.44-4.97; I = 0%), cranial nerve palsy (RR, 1.21; 95% CI, 0.53-2.77; I = 0%), and long-term stroke (RR, 2.33; 95% CI, 0.76-7.10; I = 0%), death (RR, 1.09; 95% CI, 0.65-1.83; I = 0%) and restenosis of greater than 50% (RR, 0.48; 95% CI, 0.19-1.20; I = 0%) were similar between the synthetic vs venous patch groups. Also, no differences in terms of 30-day stroke (RR, 0.31; 95% CI, 0.02-5.16; I = 63.1%), TIA (RR, 0.49; 95% CI, 0.14-1.76; I = 0%), death (RR, 0.74; 95% CI, 0.05-10.51; I = 31.7%), carotid artery thrombosis (RR, 0.13; 95% CI, 0.02-1.07; I = 0%), and long-term restenosis of greater than 70% (RR, 0.15; 95% CI, 0.01-2.29; I = 70.9%) were detected between the synthetic polytetrafluoroethylene and Dacron patch groups. The comparison between the bovine pericardium vs synthetic patch did not yield any statistically significant results in terms of 30-day stroke (RR, 1.44; 95% CI, 0.19-10.79; I = 12.7%), TIA (RR, 1.05; 95% CI, 0.11-10.27; I = 0%), local neck hematoma (RR, 4.01; 95% CI, 0.46-34.85; I = 0%), and death (RR, 4.01; 95% CI, 0.46-34.85; I = 0%).

Conclusions: Closure of the carotid arteriotomy with any of the studied patch materials seems to be similar in terms of short- and long-term end points. However, additional randomized trials with adequate follow-up periods are needed to compare bovine pericardium patches with other patch materials.
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http://dx.doi.org/10.1016/j.jvs.2018.07.023DOI Listing
October 2018

Carotid Artery Endarterectomy Versus Carotid Artery Stenting for Patients with Contralateral Carotid Occlusion: A Systematic Review and Meta-Analysis.

World Neurosurg 2018 Dec 3;120:563-571.e3. Epub 2018 Sep 3.

Department of Neurologic Surgery, Virginia Commonwealth University Hospital, Richmond, Virginia, USA.

Background: Results from studies investigating the effect of contralateral carotid occlusion (CCO) in patients with carotid artery stenosis undergoing carotid artery endarterectomy (CEA) or carotid artery stenting (CAS) are variable in the literature. We sought to determine whether CEA or CAS is the optimal revascularization approach for patients with CCO.

Methods: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effects model meta-analysis was conducted, and the I statistic was used to assess for heterogeneity. Subgroup and sensitivity analyses were performed as needed.

Results: Five retrospective observational cohort studies comprising 6346 patients were included. Patients in the CEA group had a significantly lower risk of 30-day periprocedural mortality (odds ratio, 0.46; 95% confidence interval, 0.30-0.71; I = 0%). However, no significant differences were identified in terms of stroke, myocardial infarction (MI), and major adverse cardiovascular events (MACEs) between the 2 groups. Subgroup analyses of symptomatic and asymptomatic patients did not yield significant differences for stroke, MI, and death.

Conclusions: Patients with CCO can safely undergo both CAS and CEA with similar risks of stroke, MI, and MACE. However, patients treated with CEA have a lower risk of 30-day periprocedural mortality. Future studies can help further clarify the ideal approach for these patients.
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http://dx.doi.org/10.1016/j.wneu.2018.08.183DOI Listing
December 2018

Revascularization of radiation-induced carotid artery stenosis with carotid endarterectomy vs. carotid artery stenting: A systematic review and meta-analysis.

Cardiovasc Revasc Med 2018 Jul - Aug;19(5 Pt B):638-644. Epub 2018 Jan 31.

Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address:

Objective: The incidence of carotid artery stenosis after head and neck radiation is anticipated to rise due to the increasing survival of patients with head and neck malignancies. It remains unclear whether carotid artery stenting (CAS) or endarterectomy (CEA) is the best treatment strategy for radiation-induced carotid artery stenosis.

Materials & Methods: This study was performed according to the PRISMA and MOOSE guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 20, 2017. A meta-analysis of random effects model was conducted. The I-square statistic was used to assess for heterogeneity.

Results: Five studies and 143 patients were included. Periprocedural stroke, myocardial infarction (MI) and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR: 7.09; 95% CI: 1.17-42.88; I = 0%). CEA was associated with lower mortality rates after a mean follow-up of 50 months (OR: 0.29; 95% CI: 0.09-0.97; I = 0%). No difference was identified in long-term restenosis rates between CEA and CAS.

Conclusions: Patients with radiation-induced carotid artery stenosis can safely undergo both CAS and CEA with similar risks of periprocedural stroke, MI and death. However, patients treated with CEA have a higher risk for periprocedural CN injuries and a lower risk for long-term mortality.
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http://dx.doi.org/10.1016/j.carrev.2018.01.014DOI Listing
July 2019
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