Tesis

Scoping Review: Bedah Terbuka Dan Endovaskular Sebagai Tata Laksana Stenosis Arteri Karotis Lansia = Scoping Review: Open Surgery and Endovascular Treatment for Carotid Artery Stenosis in the Elderly.

Latar Belakang: Stenosis karotis (SK) merupakan penyempitan arteri karotis akibat plak aterosklerosis dan menjadi penyebab utama stroke iskemik pada lansia. Carotid endarterectomy (CEA) dan carotid artery stenting (CAS) merupakan dua intervensi utama, namun bukti mengenai keamanan dan efektivitasnya pada populasi lanjut usia masih diperdebatkan. Meskipun terdapat uji klinis terkontrol acak (RCT) dan studi observasional yang membandingkan keduanya, kesenjangan tetap ada, khususnya di negara berkembang seperti Indonesia, di mana tindakan ini jarang dilakukan. Tujuan: Penelitian ini bertujuan untuk memetakan bukti ilmiah mengenai keberhasilan dan komplikasi CEA dan CAS pada pasien lansia dengan stenosis karotis, mengidentifikasi tren global, serta mengeksplorasi kesenjangan literatur. Metode: Scoping review dilakukan sesuai pedoman Joanna Briggs Institute (JBI) dan dilaporkan menggunakan PRISMA-ScR. Penelusuran literatur dilakukan melalui PubMed, Cochrane, Scopus, EBSCO, dan Google Scholar hingga 2025, dilengkapi dengan metode snowballing. Data yang diekstraksi meliputi karakteristik pasien, intervensi, dan luaran klinis. Hasil: Sebanyak 15 studi memenuhi kriteria inklusi, terdiri dari kohort retrospektif, studi prospektif, tinjauan sistematis, meta-analisis, dan RCT jangka panjang. Sebagian besar pasien berusia ≥70 tahun. Hasil menunjukkan pola konsisten: CEA lebih rendah dalam angka stroke dan mortalitas perioperatif, sedangkan CAS lebih sedikit komplikasi lokal seperti cedera saraf kranial dan hematoma leher. Luaran jangka panjang bervariasi; RCT melaporkan hasil sebanding, sementara data registry besar menunjukkan keunggulan survival pada CEA. Kesimpulan: CEA dan CAS sama-sama menjadi pilihan pada lansia dengan stenosis karotis, namun bukti lebih kuat mendukung CEA dalam menurunkan risiko stroke dan meningkatkan survival jangka panjang. Studi lokal di Indonesia diperlukan untuk menilai hambatan sistem kesehatan dan mendukung pengambilan keputusan berbasis bukti.
Kata kunci: Stenosis karotis, Carotid endarterectomy, Carotid artery stenting, Lansia, Scoping review


Background: Carotid stenosis (CS) is a narrowing of the carotid artery due to atherosclerotic plaque and is a major cause of ischemic stroke in the elderly. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the two main interventional strategies, yet evidence regarding their safety and effectiveness in older adults remains debated. Although randomized controlled trials (RCTs) and observational studies have compared both techniques, gaps persist, particularly in low- and middle-income countries such as Indonesia, where these procedures are rarely performed. Objective: This study aimed to map existing scientific evidence on the outcomes and complications of CEA and CAS in elderly patients with carotid stenosis, identify global research trends, and highlight gaps in the literature. Methods: A scoping review was conducted according to the Joanna Briggs Institute (JBI) methodology and reported following PRISMA-ScR guidelines. Literature searches were performed across PubMed, Cochrane, Scopus, EBSCO, and Google Scholar from inception to 2025, supplemented with snowballing. Articles were screened and extracted for patient characteristics, interventions, and outcomes. Results: Fifteen studies met the inclusion criteria, comprising retrospective cohorts, prospective observational studies, systematic reviews, meta-analyses, and long-term RCTs. Most studies involved patients aged ≥70 years. Findings revealed consistent trends: CEA was generally associated with lower perioperative stroke and mortality, while CAS was linked to fewer cranial nerve injuries and neck hematomas. Long-term outcomes varied, with RCTs suggesting comparable efficacy between both interventions, whereas large registries indicated survival benefits with CEA. Conclusion: Both CEA and CAS are viable options for elderly patients with carotid stenosis, but evidence suggests CEA provides superior protection against perioperative stroke and long-term survival. Further studies are needed in Indonesia to address healthcare system barriers and optimize evidence-based decision-making in elderly populations.
Keywords: Carotid stenosis, Carotid endarterectomy, Carotid artery stenting, Elderly, Scoping review.