Carotid Artery Stenting Versus Carotid Endarterectomy for Carotid Artery Stenosis: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Carotid artery stenosis is a significant risk factor for ischemic stroke. Two primary interventions, carotid artery stenting (CAS) and carotid endarterectomy (CEA), are commonly used to prevent stroke.

AIMS: This study systematically reviews and compares the efficacy and safety of CAS versus CEA in preventing stroke and other related outcomes.

METHODS

A comprehensive search of medical databases such as MEDLINE, Web of Science, ScienceDirect, and Cochrane CENTRAL identified relevant studies comparing CAS and CEA. Meta-analyses were conducted using a random-effects model to pool risk ratios (RRs) with 95% confidence interval (CI). Heterogeneity was assessed using I-squared statistic and publication bias were assessed using Egger's test and funnel plot.

RESULTS

CAS was associated with a significantly higher risk of stroke (RR = 1.490, 95% CI: 1.282-1.731, p < 0.001) and a borderline higher risk of restenosis (RR = 1.257, 95% CI: 1.000-1.578, p = 0.050) compared to CEA. However, CAS had a significantly lower risk of myocardial infarction (RR = 0.476, 95% CI: 0.341-0.664, p < 0.001) and cranial nerve palsy (RR = 0.079, 95% CI: 0.042-0.149, p < 0.001). No significant differences were found in all-cause mortality, TIA, or pulmonary embolus between CAS and CEA.

CONCLUSION

While CAS reduces the risk of myocardial infarction and cranial nerve palsy, it is associated with a higher risk of stroke and restenosis compared to CEA. These findings highlight the importance of individualized treatment decisions based on patient risk profiles.