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

Authors

Daryll Baker, Janice Tsui

Published in

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. Pages 108400. Jul 20, 2025. Epub Jul 20, 2025.

Abstract

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.
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.
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.
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.

PMID:
40695369
Bibliographic data and abstract were imported from PubMed on 23 Jul 2025.

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