Systematic Review and Meta‐Analysis of Dual‐Layered Stents Versus Single‐Layered Stents for Carotid Artery Stenosis

Carotid artery stenting (CAS) is widely used to treat carotid artery stenosis. However, compared with carotid endarterectomy, CAS has been associated with a higher risk of peri‐procedural stroke. Recently, dual‐layered stents (DLS) have demonstrated a lower risk of peri‐ and post‐procedural stroke. We conducted a meta‐analysis to evaluate the safety and efficacy of DLS in lowering stroke risk in patients undergoing CAS for carotid artery stenosis. A systematic search was performed through PubMed, Scopus, Embase, and Cochrane Library from inception until July 2024 for studies comparing DLS and single‐layered stents (SLS) in patients with high‐risk, lipid‐rich carotid plaques. The primary outcome was peri‐ and postprocedural stroke. Secondary outcomes included stent occlusion, restenosis, and all‐cause mortality. A random‐effects meta‐analysis derived risk ratios (RR) with 95% confidence intervals. Out of 395 results, 7 observational studies and 3 randomized controlled trials (RCTs) were included, totaling 2214 patients undergoing 2256 CAS procedures (1513 with DLS, 743 with SLS). Peri‐ and postprocedural stroke (RR: 0.33, 95% CI: 0.18–0.61; p = 0.0003; I 2 = 0%) was significantly lower with DLS. Stent occlusion (RR: 0.66, 95% CI: 0.20–2.24, p = 0.51, I 2 = 0%), restenosis (RR: 1.08, 95% CI: 0.34–3.48, p = 0.90, I 2 = 61%), and all‐cause mortality (RR: 0.83, 95% CI: 0.17–4.11, p = 0.82, I 2 = 36%) were similar between stent types. Meta‐regression found no significant predictors of stroke, including age, sex, hypertension, smoking, diabetes, and dyslipidemia. DLS use in CAS is associated with a lower risk of peri‐ and post‐procedural stroke compared with SLS. This lower stroke risk should be considered in weighing CAS treatment options.