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(Stroke. 2000;31:3079.)
© 2000 American Heart Association, Inc.

Letters to the Editor

Systematic Comparison of the Early Outcome of Angioplasty and Endarterectomy for Symptomatic Carotid Artery Disease

Nadim Al-Mubarak, MD; Gary S. Roubin, MD, PhD Jiri J. Vitek, MD, PhD

The Lenox Hill Heart and Vascular Institute of New York, New York, NY

To the Editor:

In a recent article by Golledge et al,¹ the authors attempted a meta-analysis of accumulated single-center reports to compare 30-day stroke and death risk of carotid intervention and carotid endarterectomy (CEA). The authors’ conclusion that the risk of stroke is significantly higher with endovascular intervention compared to surgery was based on an incomplete collection of reports and a scientifically flawed analysis.

For any meta-analysis to provide a reliable conclusion, it should meet the minimum standards expected from a carefully conducted randomized control trial, including the use of prospective protocols, comparable definitions of key outcomes, and the inclusion of all patients from all trials in the final analysis.² The analysis reported by Golledge et al meets none of these requirements. First, the authors had the opportunity to include a more recent series of carotid stenting^{3 4 5 6 7 8} (an important factor with a procedure in development) but failed to do so. Further, there is no mention of the large registry of multiple "single-center experience" in carotid stenting reported by Wholey et al, which demonstrated favorable outcomes from endovascular carotid therapy. This registry has recently been updated to include over 5000 carotid stent cases, with a technical success of 98.4% and 30-day event rates (all strokes/deaths) of 5.8% in symptomatic patients with extracranial carotid artery stenoses.⁹ Importantly, the authors conveniently excluded a group of 77 symptomatic patients from the Hertzer series¹⁰ that had an event rate of 19%. Similar groups are included in the endovascular series.

The analysis was based on a . . . [Full Text of this Article]

Jonathan Golledge, , MChir

Department of Vascular Surgery, Charing Cross Hospital, London, UK

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