Derivación sistemática o selectiva de la arteria carótida para la endarterectomía carotídea (y otros métodos de control en la derivación selectiva)
Appendices
Appendix 1. MEDLINE search strategy
MEDLINE 2013 to 2021
Term used "carotid endarterectomy"
MEDLINE (Ovid) 2013 to 2021 and Cochrane Central Register of Controlled Trials (lines 1 to 12)
1. Endarterectomy, Carotid/
2. exp Carotid Arteries/su [Surgery]
3. exp Carotid Artery Diseases/su [Surgery]
4. exp carotid arteries/
5. exp carotid artery diseases/
6. carotid.tw.
7. 4 or 5 or 6
8. endarterectomy/
9. (endarterectom$ or surg$).tw.
10. 8 or 9
11. 7 and 10
12. 1 or 2 or 3 or 11
13. randomized controlled trial.pt.
14. controlled clinical trial.pt.
15. randomized.ab.
16. placebo.ab.
17. clinical trials as topic.sh.
18. random$.ab.
19. shunt$.tw.
20. trial.ti.
21. or/13‐20
22. exp animals/ not humans.sh.
23. 21 not 22
Appendix 2. Embase search strategy
Embase 2013 to 2021
Terms used "carotid endarterectomy" and "carotid surgery"
Embase (Ovid) 2013 to 2021
1 carotid endarterectomy/
2 carotid artery surgery/
3 exp carotid artery disease/su
4 exp carotid artery/5 exp carotid artery disease/
6 4 or 5
7 artery surgery/ or endarterectomy/ or vascular surgery/ or surgery/
8 6 and 7
9 (carotid adj5 (endarterect$ or surgery)).tw.
10 1 or 2 or 3 or 8 or 9
11 Randomized Controlled Trial/ or "randomized controlled trial (topic)"/
12 Randomization/
13 Controlled clinical trial/ or "controlled clinical trial (topic)"/
14 control group/ or controlled study/
15 clinical trial/ or "clinical trial (topic)"/ or phase 1 clinical trial/ or phase 2 clinical trial/ or phase 3 clinical trial/ or
phase 4 clinical trial/
16 crossover procedure/
17 single blind procedure/ or double blind procedure/ or triple blind procedure/
18 placebo/ or placebo effect/
19 (random$ or RCT or RCTs).tw.
20 (controlled adj5 (trial$ or stud$)).tw.
21 (clinical$ adj5 trial$).tw.
22 clinical trial registration.ab.
23 ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.
24 (quasi‐random$ or quasi random$ or pseudo‐random$ or pseudo random$).tw.
25 ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.
26 ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.
27 (cross‐over or cross over or crossover).tw.
28 (placebo$ or sham).tw.
29 trial.ti.
30 (assign$ or allocat$).tw.
31 controls.tw.
32 shunting/ or shunt$.tw.
33 or/11‐32
34 10 and 33
Appendix 3. Search strategy for other resources
ClinicalTrial.gov (2013 to 2021)
AREA[StudyType] EXPAND[Term] COVER[FullMatch] "Interventional" AND AREA[ConditionSearch] carotid endarterectomy AND AREA[StdAge] EXPAND[Term] COVER[FullMatch] ( "Adult" OR "Older Adult" )
WHO ICTRP (2013 to 2021)
Intervention: carotid endarterectomy; Recruitment Status is: ALL
Flow diagram for updated systematic reviews
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Comparison 1: Routine shunting versus no shunting, Outcome 1: Death from all causes within 30 days of surgery
Comparison 1: Routine shunting versus no shunting, Outcome 2: Stroke‐related death within 30 days of surgery (best‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 3: Stroke‐related death within 30 days of surgery (worst‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 4: Any stroke during surgery (best‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 5: Any stroke during surgery (worst‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 6: Any stroke within 24 hours of surgery
Comparison 1: Routine shunting versus no shunting, Outcome 7: Any stroke within 30 days of surgery
Comparison 1: Routine shunting versus no shunting, Outcome 8: Ipsilateral stroke during surgery (best‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 9: Ipsilateral stroke during surgery (worst‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 10: Ipsilateral stroke within 30 days of surgery (best‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 11: Ipsilateral stroke within 30 days of surgery (worst‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 12: Stroke or death within 30 days of surgery (best‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 13: Stroke or death within 30 days of surgery (worst‐case)
Comparison 1: Routine shunting versus no shunting, Outcome 14: Haemorrhage from operation site
Comparison 1: Routine shunting versus no shunting, Outcome 15: Infection of operation site
Comparison 1: Routine shunting versus no shunting, Outcome 16: Nerve palsy postoperatively
| Shunting compared with no shunting for carotid endarterectomy | |||||
| Patient or population: patients with symptomatic or asymptomatic carotid disease Settings: hospital Intervention: shunting Comparison: no shunting | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
|---|---|---|---|---|---|
| Assumed risk (no shunting) | Corresponding risk (shunting) | ||||
| Death from all causes within 30 days of surgery | 21 per 1000 | 4 per 1000 | OR 0.45 (0.13 to 1.59) | 655 participants | ⊕⊕⊝⊝ |
| Stroke‐related death within 30 days of surgery (best‐case) | 12 per 1000 | 0 per 1000 | OR 0.13 (0.02 to 0.96) | 655 participants | ⊕⊕⊝⊝ |
| Stroke‐related death within 30 days of surgery (worst‐case) | 9 per 1000 | 1 per 1000 | OR 0.37 (0.05 to 2.62) | 655 participants | ⊕⊕⊝⊝ |
| Any stroke during surgery (best‐case) | 39 per 1000 | 7 per 1000 | OR 0.42 (0.16 to 1.07) | 655 participants | ⊕⊕⊝⊝ |
| Any stroke during surgery (worst‐case) | 24 per 1000 | 41 per 1000 | OR 1.32 (0.52 to 3.38) | 655 participants | ⊕⊕⊝⊝ |
| Any stroke within 24 hours of surgery | 53 per 1000 | 0 per 1000 | OR 0.15 (0.03 to 0.78) | 214 participants | ⊕⊕⊝⊝ |
| Any stroke within 30 days of surgery | 45 per 1000 | 26 per 1000 | OR 0.77 (0.35 to 1.69) | 655 participants | ⊕⊕⊝⊝ |
| *The basis for the assumed risk is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk and the relative effect of the intervention group (and its 95% CI). CI: confidence interval; GRADE: Grades of Recommendation, Assessment, Development and Evaluation; OR: odds ratio | |||||
| GRADE Working Group grades of evidence | |||||
| a Downgraded by one level due to serious risk of bias as evidence used an inappropriate random sequence generation, had imbalanced surgeon assignment between groups, and had imbalance in the baseline characteristics between groups b Downgraded by one level due to imprecision as the evidence had a wide CI | |||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Death from all causes within 30 days of surgery Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.45 [0.13, 1.59] |
| 1.2 Stroke‐related death within 30 days of surgery (best‐case) Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.13 [0.02, 0.96] |
| 1.3 Stroke‐related death within 30 days of surgery (worst‐case) Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.37 [0.05, 2.62] |
| 1.4 Any stroke during surgery (best‐case) Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.42 [0.16, 1.07] |
| 1.5 Any stroke during surgery (worst‐case) Show forest plot | 3 | 655 | Odds Ratio (IV, Fixed, 95% CI) | 1.71 [0.57, 5.09] |
| 1.6 Any stroke within 24 hours of surgery Show forest plot | 2 | 214 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.15 [0.03, 0.78] |
| 1.7 Any stroke within 30 days of surgery Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.77 [0.35, 1.69] |
| 1.8 Ipsilateral stroke during surgery (best‐case) Show forest plot | 3 | 737 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.42 [0.17, 1.08] |
| 1.9 Ipsilateral stroke during surgery (worst‐case) Show forest plot | 3 | 737 | Odds Ratio (IV, Fixed, 95% CI) | 1.71 [0.58, 5.09] |
| 1.10 Ipsilateral stroke within 30 days of surgery (best‐case) Show forest plot | 3 | 737 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.41 [0.18, 0.97] |
| 1.11 Ipsilateral stroke within 30 days of surgery (worst‐case) Show forest plot | 3 | 737 | Odds Ratio (IV, Fixed, 95% CI) | 1.22 [0.46, 3.23] |
| 1.12 Stroke or death within 30 days of surgery (best‐case) Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.62 [0.31, 1.27] |
| 1.13 Stroke or death within 30 days of surgery (worst‐case) Show forest plot | 3 | 655 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.81 [0.40, 1.66] |
| 1.14 Haemorrhage from operation site Show forest plot | 2 | 641 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.19 [0.07, 19.47] |
| 1.15 Infection of operation site Show forest plot | 2 | 641 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.16 [0.00, 8.12] |
| 1.16 Nerve palsy postoperatively Show forest plot | 1 | 138 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 1.81 [0.30, 10.82] |
