A Meta-Analysis of Transfemoral Endovascular Treatment of Common Carotid Artery Lesions

Objective: High-grade stenoses of the common carotid artery (CCA) are rare and represent a therapeutic dilemma for the treating physician. Endovascular treatment through antegrade access has been proposed as a less invasive treatment option. The aim of this study was to review the existing literature on such a procedure.

Methods: A meta-analysis of all studies reporting on endovascular treatment for the treatment of CCA was performed.

Results: Six studies, including 227 patients, were identified. Forty-nine percent of the patients were male, and 55% symptomatic. Lesions were located in CCA in 237 cases, in innominate artery in 4 cases, combined with internal carotid artery in 28 and subclavian artery in 5 cases. The reported technical success of the procedure was 97.9%. In the 234 successful endovascular treatments, a stent was implanted. Thirty-day mortality and stroke rate were 0.4% and 3.1%, respectively. During a mean follow-up of 8.4 to 31.7 months, 4 patients presented symptoms of cerebral ischemia and 18 died (none related to the procedure). Thirty-one patients developed restenosis of the CCA lesion; successful repercutaneous transluminal angioplasty was performed in 9 cases.

Conclusions: This meta-analysis reported the largest collection of patients having undergone endovascular treatment of CCA stenosis or occlusion. Results from this study showed that 30-day mortality and stroke rate were 0.4% and 3.1%, respectively. The procedure is absolutely effective, and no significant change of stroke was found with or without an embolic protection device. In sum, balloon angioplasty with stenting of the component of this disease should be pursued to decrease the risk of stroke.