Effect of CEA and CAS on Quality of Life and Functional Status Studied

June 30, 2015—Leonard Shan, MD, et al published a systematic review and meta-analysis of quality of life (QOL) and functional status after carotid revascularization in the European Journal of Vascular & Endovascular Surgery (EJVES; 2015;49:634–645).

The background of the study is that the direct QOL effect of revascularization by either carotid endarterectomy (CEA) or carotid artery stenting (CAS) is unclear. Therefore, the investigators conducted reviews of (a) QOL after CEA, (b) QOL after CAS, (c) QOL differences between CEA and CAS, and (d) QOL compared with reference populations.

As summarized in EJVES, the investigators used Medline and Embase for sources of data and followed the PRISMA guidelines. Using strict eligibility criteria, they selected clinical studies published after January 1990. Quality appraisal and data tabulation were performed using predetermined forms. Data were synthesized by narrative review and random-effects meta-analysis using standardized response means. Heterogeneity and bias were assessed. Twelve studies composed of a total of 4,224 patients, including two randomized controlled trials, were reviewed.

The investigators reported that despite an initial decline in QOL after CEA, quantitative and qualitative analysis of the SF-36 questionnaire showed all domains returned to baseline by 1 year. Preliminary data suggests that QOL after CAS does not have an initial decline, especially in physical health domains. QOL is similar between CEA and CAS at 1 year. Comparisons to reference populations are inconclusive. The meta-analysis was limited by significant statistical and methodological heterogeneity, advised the investigators in EJVES.

The investigators concluded that revascularization by either CEA or CAS maintains preoperative QOL with minimal differences between the two approaches. This review reaffirms the success of carotid revascularization in preventing the devastating consequences of stroke on QOL and functional status, stated the investigators in EJVES.