A systematic review and meta-analysis of the late causes of death following successful carotid endarterectomy (CEA)

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-07-20 DOI:10.1016/j.jstrokecerebrovasdis.2025.108400

Daryll Baker FRCS PhD (Consultant Vascular Surgeon) , Janice Tsui FRCS MD (Consultant Vascular Surgeon)

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引用次数: 0

Abstract

Introduction

Carotid endarterectomy (CEA) reduces the risk of stroke. Knowledge of the eventual causes of death would assist in directing late post-CEA drug management. This review determines the causes of death and assesses whether this has changed over time and is influenced by CEA indications or preoperative coronary artery disease status.

Methods

Using PRISMA guidelines, the PROSPERO registered review identified only randomised controlled studies where the cause of late post-CEA death was reported by interrogating the PubMed and Cochrane databases. Titles and abstracts were reviewed, and publication bias was assessed once inappropriate studies had been removed. From the extracted data, a proportional meta-analysis of the non-stroke cardiovascular, stroke and cancer-related deaths was undertaken. A random effect model was used to pool proportions. For each, linear regression analysis determined the effect of changes in the proportion of deaths over time, symptomatic CEA indications, and preoperative coronary artery disease status.

Results

From 3838 publications between 1965 and 2025, 27 studies provided information on the late cause of death. 47.1 % (95 % CI 42.2 to 52.0) of deaths were non-stroke cardiovascular-related. This proportion has decreased in more recent publications (r = 0.61, p < 0.001). 6.3 % (95 % CI 4.5 to 8.4) of late deaths were stroke-related, which did not alter over time. 17.5 % (95 % CI 13.7 to 21.7) of late deaths were cancer-related. This proportion has increased with time (r = 0.59 p < 0.001). The indications for CEA or the preoperative coronary artery disease status did not influence the proportion of deaths.

Conclusions

Post-CEA, almost half die from cardiovascular causes. A reduction in this proportion may indicate an improvement in treatment. The 6 % post-CEA stroke-related death rate is low compared to the overall proportion of recurrent fatal strokes and may indicate the success of CEA. Further outcome improvements can be achieved by focusing on general cardiovascular treatments rather than stroke-specific ones.

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颈动脉内膜切除术（CEA）成功后晚期死亡原因的系统回顾和荟萃分析

颈动脉内膜切除术（CEA）可降低中风的风险。了解最终的死亡原因将有助于指导cea后晚期的药物管理。本综述确定了死亡原因，并评估死亡原因是否随时间而改变，是否受CEA指征或术前冠状动脉疾病状态的影响。方法：采用PRISMA指南，通过查询PubMed和Cochrane数据库，PROSPERO注册综述仅确定了随机对照研究，这些研究报告了cea后晚期死亡的原因。对标题和摘要进行审查，并在删除不适当的研究后评估发表偏倚。从提取的数据中，对非卒中心血管、卒中和癌症相关死亡进行了比例荟萃分析。随机效应模型用于汇总比例。线性回归分析确定了死亡比例随时间变化、症状性CEA指征和术前冠状动脉疾病状态的影响。结果：从1965年至2025年的3838份出版物中，有27项研究提供了晚期死亡原因的信息。47.1% （95% CI 42.2 - 52.0）的死亡与卒中心血管无关。这一比例在最近的出版物中有所下降（r = 0.61,p < 0.001）。6.3% （95% CI 4.5 - 8.4）的晚期死亡与中风有关，这一比例不随时间变化。17.5% （95% CI 13.7 ~ 21.7）的晚期死亡与癌症有关。这一比例随着时间的延长而增加（r= 0.59）。结论：cea后，几乎一半的患者死于心血管原因。这一比例的降低可能表明治疗的改善。与复发致死性卒中的总体比例相比，CEA后卒中相关死亡率为6%，这可能表明CEA的成功。进一步的结果改善可以通过关注一般心血管治疗而不是针对中风的治疗来实现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.