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Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis
  1. Juan Fulgencio Welko Mendoza1,
  2. Carolina de Oliveira Cruz Latorraca1,
  3. Ricardo de Ávila Oliveira1,2,
  4. Daniela Vianna Pachito3,
  5. Ana Luiza Cabrera Martimbianco4,5,
  6. Rafael Leite Pacheco1,5,
  7. Rachel Riera1,3
  1. 1 Discipline of Evidence-Based Medicine, Universidade Federal de São Paulo (Unifesp), São Paulo, São Paulo, Brazil
  2. 2 Department of Surgery, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil
  3. 3 Center of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
  4. 4 Postgraduate of Health and Environment, Universidade Metropolitana de Santos, Santos, São Paulo, Brazil
  5. 5 Medical Research Center, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
  1. Correspondence to Mr. Rafael Leite Pacheco, Discipline of Evidence-Based Medicine Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil ; rleitepacheco{at}


A review of systematic reviews (SRs) and a critical appraisal study was conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). The objectives of this review are (1) to identify all published SRs comparing the effectiveness and safety of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for carotid artery stenosis, (2) to assess their methodological quality and (3) to compare the primary studies contained in each SR. We included 17 SRs published between 2005 and 2017. None of the SRs fulfilled all items of AMSTAR-2. The overall confidence in the results was graded as critically low for 16 SRs (94%) and low for 1 SR (6%). Five items were judged inadequate in all SRs: reference to a published protocol, explanation to the selection of study design, comprehensive search of the literature, methods for statistical combination of findings and consideration of the risk of bias on the results of meta-analysis. In total, 15 randomised clinical trials (RCTs) were included at least in one SR. The number of included RCTs in each SR was inconsistent (4 to 15) and was not related to the year of publication of the SR. Our study found redundant and low methodological quality SR comparing CAS versus CEA for carotid stenosis.

  • stroke medicine
  • vascular surgery

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  • Contributors RR, JFWM and RAO: conception and design; RLP, COCL and ALCM: drafting the work; DVP, RR and RAO: revising content; acquisition and analysis and final approval: all authors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.